Why hire a doula? Simkin has devoted a good deal of her professional life to working as a doula and training others to be doulas. She has attended approximately 300 births, "which," she contends, "is not a lot." She explained the advantages of having a doula present, even when the laboring woman is surrounded by friends, family, her partner, and midwives or nurses.

"In comparing a doula to a best friend or the woman's mother or sister, the difference is the experience and the perspective of the doula, and her hands-on knowledge. Doulas have had training in a variety of situations, such as when labor slows down, or if the mother becomes discouraged, or if she's having back pain. And someone who truly cares for the woman may offer love and stay with her, but may not have ideas of things to try. Having that well-rounded knowledge and experience with many laboring women means the doula offers benefits that a friend couldn't have. Comparing a doula with a partner, I think the partner brings things that no one else can bring. He or she loves the woman more than anybody else, he or she knows her better than anybody else, which are wonderful things.

"But one of the disadvantages is that it's awfully hard sometimes to watch the person you love in pain, or frustrated or discouraged with a lack of progress. And there's a tendency to want to rescue her from that. Partners do not have the objective, calm perspective and experience that a woman needs and a doula has. Sometimes the woman doesn't need to be pitied, or rescued. What she needs is someone to say, 'you're OK, this is all right, you're going to get through this, let me help you.' But she also needs someone with a perspective on when to throw in the towel, and to recognize that this is not going normally, or that we need some interventions here. Furthermore, sometimes the doula can speak with the [hospital] staff, in a liaison capacity, with a little more confidence than the partner can.

"And finally, when compared to nurses and midwives who have clinical responsibilities that have to take priority over the mother's emotional needs, the doula can always remain beside the woman as a continuing source of nurturing encouragement and reassurance. Also, nurses and even some midwives are often not skilled in some of these hands-on comfort measures used by doulas."

Simkin says she is heartened by what she sees as an increase in the popularity of doulas. "Doulas are the most positive innovation I've seen. And that's because they fit in anywhere: at home, at the hospital, at birth centers. Doulas appeal to many women and their partners -- the idea of having someone there just for them, who has no other obligations, no shift changes -- even fathers who want to play the primary support role are relieved to know there's going to be someone there reminding them and helping out and giving them a break if necessary and offering perspective. The doula is the most significant change that's taking place on in the direction of woman-centered childbirth." "Doulas are the most positive innovation I've seen. And that's because they fit in anywhere: at home, at the hospital, at birth centers."
- Penny Simkin

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