We've been featuring each of the Six Lamaze Healthy Birth Practices in our series of blog carnivals, and this time we're talking about labor support. Healthy Birth Practice #3 is, 'Bring a loved one, friend, or doula for continuous support.'

A national survey of women who gave birth in U.S. hospitals in 2005 reported that only 3% had supportive care from doulas, despite evidence that doula support improves health outcomes and is rated more highly than other forms of labor support. In fact, a recent review of evidence-based labor and delivery care published in a prominent obstetric journal rated doula care 'one of the most effective interventions'. Doula support may be rare in part because insurance does not typically reimburse for doula services, a situation that may soon change (pdf) in the United States. In other cases, women may be confident that their partners, care providers, or carefully selected loved ones will provide excellent support, and do not perceive the need for a doula. Unfortunately, some women probably underestimate the importance of labor support, or assume they will automatically get support from hospital staff, and don't assemble a support team carefully.

The bloggers who participated in this carnival share a powerful collective voice about the importance of excellent labor support, whoever the person is providing it. Hopefully, together we've impressed upon readers that labor support should be given careful consideration in planning for a healthy, safe, and satisfying birth experience. Many thanks to all who shared their insights and perspectives. It's yet another fantastic carnival!

A bunch of bloggers weighed in on why continuous support matters.

Desirre Andrews at Preparing for Birth shares advice on assembling a labor support team and tops it off with some great quotes from women themselves about why a supportive birth team was important to them. The Well-Rounded Mama discusses the benefits of continuous support for women of size, and reviews the importance of a size-friendly, birth-friendly support team. Wendy Martijn at Aruban Breastfeeding Mamas answers some frequently asked questions about labor support, such as whether a doula will eclipse the partner's role. Kathryn Lane Berkowitz at The Birth Whisperer reminds her readers of the often-cited quote: 'if doulas were a drug, it would be unethical not to use it' and implores every childbearing woman to give herself the gift of a doula, a good reminder during this gift-giving season. Lest we believe that doulas are an extravagant gift, Jill of Unnecesarean fame blogging at The Birth Activist debunks the notion that bringing a doula along means a woman is in selfish pursuit of a 'nice experience.' Anne at Dou-la-la makes a case for support extending beyond labor and birth and well into the postpartum period. She writes, 'After the long buildup of pregnancy, and the transforming apex that is birth, with much societal (not to mention medical) attention paid to both, many women often get the relative equivalent of a handshake and a 'good luck!' Women and babies deserve more.'

But when we talk about the benefits of continuous support in labor, let's be forthright. Andrea Lythgoe (who writes the Understanding Research series for Science & Sensibility) reviews the latest data on doulas, tells us why we shouldn't be citing the older data, and shares with doulas some advice for communicating about research findings.

But don't most women already have great support in labor without bringing along a doula?

Some certainly do. Molly (a doula herself) at Feminist Childbirth Studies writes about the many attributes of her partner that made him her perfect 'doula', and some of the details of the labor support job description. Megan at Velveteen Mind heaps some serious praise on her nurse, Hazel (who happened to be a Lamaze-certified Childbirth Educator, too.) Together, they turned what could have been a tricky labor into 'delicious' experience birthing her daughter.

But several bloggers explore the difficulty hospital staff face in providing effective labor support.Carol Van Der Woude writes that Dr. Lamaze made sure everyone in his hospital who came in contact with the laboring woman was trained in his relaxation and comfort techniques whereas today there is much variability in the support skills of hospital staff, as machines and procedures transform nursing into a technical rather than a supportive role. In a similar vein, Rosie at Rosie's Adventures in Birth and Beyond debunks the notion that hospital staff can consistently provide excellent support and privacy, pointing out that a doula can be a knowledgeable companion creating an intimate space for the woman and her partner amidst the unfamiliar hustle and bustle of a typical labor and delivery floor. Nicole, a hospital-based midwife who blogs at It's Your Birth Right gives her own take on why a doula can ease the uphill battle many women face to have a natural birth in the hospital. Janelle, another hospital-based midwife and new to the blogging scene blogging at Birth Sense, also explores the difficulty of getting consistent, quality support from hospital staff, acknowledging that labor support is hard work that not everyone is cut out for.

What exactly does that hard work look like?

Good question. Thankfully several doula bloggers shared a little more about what they do. Nicole at Bellies and Babies shares a simple but inspiring story of a birth she attended as a doula. Rebecca at Public Health Doula shares a poignant collection of thoughts on why she is a doula, and shows that a good doula can provide whatever kind of support the unique circumstances call for. Amy Catania at ChicagoDoula agrees, showing that doula support in labor 'can look however a laboring mother needs it to look.' Sheridan at the Enjoy Birth Blog points out that a good doula will understand each woman's individual plan for birth and, with the proper background, can work with some women to use special technique such as Hypnobabies that involves verbal cues and focusing strategies. Rachel Leavitt at The Beginning of Motherhood begins her post with a dream sequence (more like a nightmare) of having to labor with no support from a doula, midwife, or partner, and having only a stranger giving orders. She counters with a collection of stories about both receiving and giving empowering, loving support in labor. Although I am a midwife, not a doula, I was inspired by a video compilation of images of doulas in action in a recent guest post on DrGreene.com. I pondered whether, in the era of YouTube and Facebook, the ability to so easily find images of supported women giving birth might compel more women to seek out this kind of care.

So how can more women have access to doulas?

Miriam Perez at Radical Doula recently compiled a list of volunteer doula programs in the United States, organized by state. If you know of one not on the list, let her know! I'll bend the rules and share a non-blog link, now. Another resource we all should be aware of is DoulaMatch, a site that helps expectant women find local doulas (in the U.S. or Canada) and view their credentials, availability, and consumer testimonials. (It's a bit like The Birth Survey, but for doulas!) Between these two new resources, far more women should be able to access doulas than ever before.

Thanks so much to everyone who participated in this carnival! I know it took me forever and a day to post it so I thank you all for your patience, too. The next carnival topic will be about interventions in labor and birth. Put your thinking caps and blogging gloves on. Posts will be due after the holidays!

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