is a doula an indulgence?

only last night my poor sister got caught up in a conversation where she mentioned that i am now a doula and the woman she was talking to was ....um....maybe we could describe it as scratchy. "why do people need support in pregnancy and birth?" was her question. i know the lady is a mother of two and i guess she figures she managed, so should everyone else but there are lots of very good answers to the question:

very simply put, if a lady wishes to be supported by a caring, knowledgeable professional and is prepared to pay for it, why not?

if there is no doula, who will support the mum? there is a general expectation that the father of the baby will act as labour support but daddy might be absent due to work commitments or not feeling up to fatherhood; he might be physically present but emotionally absent due to being overwhelmed or not childbirth educated; he might see childbirth as womens business (for personal or cultural reasons); he might be a marvellous support person but labour might start when he is tired from a long day or it might go on so long that no mortal could be expected to be the only support for that whole time or he might be trying hard but a bit scared and lost. when the dad (or any other bystander) is anxious and producing the hormones of stress and fear those hormones will affect the labouring mum. stress hormones are not compatible with labour and labour will slow or stall, increasing the risks of interventions. 

very often a  mother will invite her own mother/friend/sister to be present at the birth, which can be great but sometimes times these people are not physically close enough to attend or they can bring fear and stress to the birthing room, especially if they have suffered traumatic births themselves. 

even the very best hospital staff can be too busy to be truly available to the mama, sometimes they are lacking bedside manner, sometimes they are wonderful but there is a shift change and everyone has to adjust to a new style of caregiver.

why does mum need support?

if this is a first baby mum faces the unknown and no matter how easy the pregnancy has been, how healthy she is or how well prepared the unknown is always at least a little bit scary. then there are the times when motherhood can be expected to be a challenge: when mum is young and/or unsupported, when mum is a recent arrival in a new land, when dad has left or is difficult to deal with, or is flat out dangerous, when baby is known to have health problems etc.

>in so many situations the mother faces some compromise to her ability to relax and enjoy motherhood. at these times the hormones of stress and fear slow labour and they also course through baby. not only is that unpleasant for bub but the period around birth is a time when baby's brain is extremely plastic and the emotions experienced by the mother/baby at the time of and immediately after birth will predispose that baby to feeling those emotions throughout their life. nobody wants to see mothers endure emotional pain or physically traumatic births and neither do we as parents or society want our children to suffer more fear, anxiety or insecurity than the process of living will naturally bring them.

a smooth (or smoother) transition is good for society!

okay, so if there is a doula the transition to motherhood is supported and baby's journey earthside is nicer but what is the value in "nicer"? 

doula supported birth sees a 50% reduction in caesarean section rates and while its hard to find and compare costs for different births, it is estimated that the NHS pays an extra 800 pound for each caesarean performed. US costs can be up to $10 000 extra for c-section, that is the cost of 5 very well paid doulas! insurance would often cover that cost but when insurance pays, we all pay.
doula supported births lead to better breastfeeding, more confident mothers, reduced post-natal depression, reduced birth trauma, reduced epidural rates and lower incidence of assisted delivery. every single one of these benefits will reduce costs to our society through improved health outcomes and lower out-of-pocket expenses from the very beginning.
and all of that is the somewhat measurable benefit, there is also the long term, difficult to define and measure cascading benefit to mental health and happiness.

for the family who pays for a doula it may seem an indulgence, one of those life enhancing decisions we make but cant quantify the effect, just like eating organic food or having a new car or indulging in expensive hobbies but for society as a whole i dont think they are the slightest bit indulgent, more like an investment in the future of our families and our health. doulas really and truly have the power to change the world, baby by baby, family by family until a ripple becomes a tsunami.