Doulas Need to Provide Support Before Active Labor

As a childbirth educator and a doula, I had been asked on multiple occasions, “At what point in labor should my doula support start?” Different doulas have different policies when it comes to this question. Some doulas don’t provide support until you are in active labor. Personally, I find that the latent phase of labor, which occurs well before active labor, is the hardest part for most parents. Though many doctors consider the latent stage to last until the cervix dilates to 4 cm, new evidence is showing it lasts even longer, and according to the American College of Obstetricians and Gynecologists, the latent phase really should be considered to last until 6 cm dilation. The latent stage can last several hours, but it can also last several weeks. During this time, mothers are often excited, nervous, and sometimes may even start to doubt their ability to labor. Consequently, the emotional support they receive at this point in labor effects the outcome of their entire labor process. 

As soon as I get a text from my client that she is in labor, I like to get on the phone. Based on what she says and the sound of her voice, I can make suggestions. I continually stand by to provide support over FaceTime by encouraging her to try out different positions and other comfort measures. As she starts to progress, we discuss at what point she should go to the hospital and when I should arrive. Every mother is different, but it is important that I provide support during the latent stage, before active labor starts. Guidance and reassurance at this stage help clients feel safe and confident with their decision-making. If they choose to go to the hospital too soon, they may not be able to labor freely in the more confined space, while if they choose to remain at home longer, they would have more freedom to move around. According to Evidence Based Birth, using upright and active positions during the first stage of labor leads to shorter overall labor and less need for epidurals.

One scenario in which your doula’s presence is necessary early on is in the case of PROM (pre-labor rupture of membranes). This is when a woman’s amniotic sac breaks before labor starts. In most cases of PROM, doctors want women to come in right away to make sure that both she and the baby are okay. Some people do not have their doulas meet them at the hospital until they are actually in active labor. However, in my experience, it is so important to have your doula’s presence with you when you at the hospital. Doulas help clients self-advocate and ask the right questions when it comes to the woman’s and the baby’s health status. Doulas help clients ask questions about their care so that they can make confident choices with their doctor. Early informed decision-making ultimately decides the route of the entire birth.  

In 2017, one of the largest and systematic reviews in the Cochrane Library was updated. It studied the experiences of 15,858 women and found that continuous support provides amazing benefits to women giving birth. They defined “continuous support” as “some combination of comfort measures, emotional support, provision of information, and advocacy on behalf of the woman, provided from at least early labor (before 6 cm dilation) or within one hour of hospital admission (for admission with greater than or equal to 6 cm dilation), through until at least the birth, and provided by a person whose sole responsibility is to provide support to the woman, as continuously as practical in a given context.” Women who were continuously supported were more likely to give birth spontaneously (without the use of ventouse, forceps, or cesarean), not to use pain medications, to have shorter labors, and to be overall more satisfied with their birth experience. Clearly, women need to have support starting from early labor, as it affects the overall labor process. 

Birth and labor are unpredictable, and in the end, your baby ultimately decides what route he or she may take. However, the one thing you can control is when you want your doula to support you. I believe establishing strong communication with parents at an early stage of labor and supporting them holistically throughout the whole process leads to a satisfying birth experience. In the end, attending a birth for many hours feels worth it to me. I don’t want to miss out on a single moment of supporting parents whom I care deeply about. Above all, I want them to have great memories of the special day their baby arrived in the world.