The Doula Effect

How and Why Doulas Help Mothers Have Shorter Labors, Less Pain, and More Satisfying Births

Description: It is widely known that continuous doula care during birth shortens labor, with mothers experiencing less pain, having less interventions and greater birth satisfaction. What is unknown is why this “doula effect” exists and why it has not been imitated in research on midwives or nurses. In this informative, research based session, Gilliland presents her original thesis and dissertation research using the application of attachment theory to explain the “doula effect”. After hearing this presentation, Marshall Klaus, MD, one of DONA International’s founders, stated that it offered the best explanation for why doulas influence birth outcomes.

Research Abstract: Doula support practices of mothers during labor and birth are complex processes that involve attachment behaviors, therapeutic strategies, and communication skills. Similar to the infant relying on a primary caregiver as an attachment figure, the mother relies on the doula as a secure base during labor. In both situations the doula and caregiver are available for assistance; can accurately perceive her emotional needs; effectively represent her interests; are strong and capable physically and emotionally; and have resources that the mother or infant does not possess. Additionally, the rhythm and ritual of labor support set the stage for attunement between doula and mother, similar to the attunement process between mother and infant outlined by Daniel Stern.

This research is significant since it provides a strong theoretical basis why doulas are effective; namely that they provide a focus for attachment behavior and provide a secure base for the laboring mother. The doula as a secure base theory also offers a well developed explanation why nurses have been shown to be less effective than doulas in obtaining the same outcomes. Except in unusual situations, nurses and fathers are unable to fulfill many of these attachment functions for mothers. With further development, this may become the fundamental theory of doula support.

Objectives: By the end of this session, participants will be able to:

  1. Explain why the doula is a focus for the mother’s attachment behavior and how the doula is uniquely situated to meet a laboring mother’s attachment needs.
  2. Describe the five functions of a secure base during labor.
  3. Illustrate what attunement is and how the doula and mother work together to create this unique state of consciousness.

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