At the International Doula Institute, we support all births. However, as doulas, we know that evidence shows unnecessary c-sections increase risks to both the birthing person and the baby. Unnecessary c-sections are not to be confused with medically necessary ones. C-section birth is necessary in some situations. However, there is often a correlation between higher vaginal birth rates and improved maternal infant outcomes.
An important part of our role as doulas is to help clients have safe and empowering births. That role includes providing evidence-based information and support. Vaginal birth remains the safest outcome for the most birthing people. The World Health Organization recommends a c-section rate of about 15%. This means 85% of births can safely be vaginal births.
Yet many places, like the US, have c-section rates over 30%. It is not surprising then that the US also has poor maternal infant health outcomes.
So, how do doulas improve vaginal birth rates? There are a few ways we help:
Doulas Help Educate About Provider Options Which Can Increase Vaginal Birth Rates
As a doula, education is one of the most important services we provide. People do not know what they do not know. It’s common, especially in the US, to simply go to the most convenient OB office for prenatal and birth care.
Helping families understand all provider options from the different types of midwives to family providers, to obstetricians can increase a family’s likelihood of a vaginal birth.
How? Different providers have different c-section rates. Certainly, there are variables involved such as the demographic a provider typically serves (e.g., a high-risk provider). However, when a family chooses a provider with lower c-section rates, they increase their likelihood of a vaginal birth.
Midwives are low risk providers for low-risk birthing people pregnant with health babies. When someone is low to middle risk and they give birth with a midwife, both in and out of the hospital, they can increase their likelihood of a vaginal birth.
Providing information about provider types and questions to ask their OB or midwife can help you support clients in reducing their risk of a c-section.
Prenatal Childbirth Education
While doulas are not childbirth educators, they can provide basic ‘what to expect’ education for families. Doulas can also become childbirth educators, or they can refer families to educators for comprehensive childbirth education.
When families know what to expect, birthing options, positioning, staying mobile, etc., they can make informed decisions about their birth plan to reduce their risk of a c-section birth.
Continuous Labor Support Increases Vaginal Birth Rates
Birthing people who have continuous labor support report more satisfaction with their birth experience. However, they also increase their chances of a vaginal birth. The ACOG study looking at how to reduce primary c-sections shows continuous labor support reduces c-sections as well as other interventions.
Continuous labor support is an evidence-based way to improve birth outcomes.
Having a doula at a birth increases:
- Vaginal birth rates
- Birthing person’s self esteem
- Breastfeeding rates at 6 weeks postpartum
- Satisfaction with birth
Having a doula also reduces the likelihood of:
- Using pharmacological pain relief
- Induction and augmentation of labor
- Vacuum or forceps assisted birth
- C-section birth
Our continuous labor support is an important part of helping families increase the likelihood of vaginal birth.
Doulas Help Families Stay Upright and Moving
When a birthing person is upright and mobile, they are less likely to have slower labor. Movement during labor helps to facilitate baby’s movement to get into an optimal position. Gravity assists in keeping baby’s head applying pressure to the cervix helping contractions be more efficient.
During the second stage, pushing, being upright assists in baby’s descent through the birth canal. Being able to move into the right position allows the birthing person’s pelvic to be open and make it easier for baby to turn as needed.
Doulas assist families in making informed decisions during birth which often includes the choice to be upright and mobile as much as possible during labor and birth.
Doulas Build Confidence
As a doula, you spend a lot of time communicating with families prenatally as well as during birth. Helping families understand their body’s designed for birth and building their confidence is an important part of supporting increasing vaginal births.
Certainly, there are situations where a c-section is necessary. However, we educate and build confidence that they can make informed decisions and be active participants to reduce the likelihood of an unnecessary c-section. Should a medical reason pop up, they know it is a medical need and not due to anything they’ve done.
When people feel confident in birth and how to make informed decisions, they are more likely to push for the birth they hope for rather than any birth a provider is pushing for.
Regardless of how a client gives birth, you are there to support them. However, you have the skills and support to help clients avoid unnecessary c-sections and improve vaginal birth rates overall.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...