The most important thing I learned when I was working as a nurse-midwife at an obstetric ward was that every mother wants to have a special, wonderful childbirth experience. This is true even though the birth itself is of diverse and mostly uncontrollable processes. Let me share two birth stories with you.

A young mother had gained almost 50 lbs during pregnancy. Her obstetrician and all the nurse-midwives expected that her labor would be long because of her excessive weight gain. However, her labor unexpectedly progressed so rapidly that she gave birth in the labor room, not in a delivery room, soon after her husband arrived, surrounded by her family members. There was no medical staff present at that moment. It was so fortunate that she had no vaginal wound or heavy bleeding and her big baby was very healthy. From the perspective of current medicalized childbirth, such an incident is usually regarded as dangerous and unacceptable. It was, however, to me, just a natural birth. Instantly, I told her that how wonderful she and her baby were, because she was able to go through childbirth very well on her own. The obstetrician supported us with reassurance. She looked relaxed by our praise. I apologized that I could not attend her during her birth. The relationship between her and the staff was not damaged at all. On the contrary, she became a more confident mother than other mothers, and she enjoyed childrearing with successful breastfeeding. She and her husband later invited me to their home, and we talked about her childbirth many times.

Another mother had an emergency cesarean section and delivered a healthy baby. As her labor progressed, her fetal heart rate dropped, and the obstetrician concluded that she should have a cesarean section. They went through the process of informed consent, but due to the circumstance, it was unlikely that the mother could really pay attention. I was concerned that she did not talk about her childbirth experience during her hospitalization. Just before she went home on the 10th postpartum day, I asked her if her childbirth experience was positive. I learned that, in fact, she did not understand why she suddenly needed a cesarean section. Still, she was happy to have a healthy baby. The informed consent process did not work for her after all. I explained to her the labor process that she and her baby had experienced, showing her the fetal heart rate records. She listened to me seriously, and then, I saw her smile for the first time!

Childbirth is the essential event of a woman's life as a mother. It is health care providers' duty to help make the mother' s everlasting memory of her childbirth experience special. Mothers and their family members are so sensitive to what they are told by obstetricians and nurse-midwives that they remember it for a long time. Sometimes parents sue their obstetrician and/or nurse-midwives, because of unforeseen childbirth outcomes themselves, or because the parents feel that they and their baby were not respected or fully informed by medical staff. Thus, their memories and experience that should have been happy are damaged.

I became interested in the nature of humanistic care in labor and childbirth to help the mother's birth experience to be special. As a result, I am studying the practice, training, and professionalization of doulas in the U.S. "Doula" is a Greek term meaning "a woman's servant." A doula typically attends a mother's childbirth continuously, encouraging, massaging, and praising her, like "mothering the mother." Dr. Dana Raphael, an anthropologist, first introduced this term into the maternal-child care field, mainly referring to breastfeeding support. Then, many researchers such as Dr. Klaus and Dr. Kennel, pediatricians, studied the effects of doula support on various childbirth outcomes. Many studies concluded that doula support may reduce the rates of medical interventions during labor and birth and may have positive psychological effects such as increasing mothers'self-esteem and satisfaction with their childbirth experience. In particular, the effects are striking in regard to socially disadvantaged populations such as low-income, teen mothers, or minority women. However, even in socially advantaged populations, several studies revealed that the mothers who were taken care of by a doula had better experiences.

Consequently, I think that doula care is worthwhile considering in Japan. The majority of people in Japan are affluent and middle-class. Japan has the best health care system and has achieved the lowest rates of infant and maternal mortality rates in the world, but social connections in the community are being weakened. While we do have to appreciate and maintain the achievements of our health care system, socio-psychological support by doulas may humanize childbirth care to make mothers happier and more confident. I plan to promote research and practice regarding doulas when I return to Japan in a few years!

Reference
Klaus, M. H., & Kennell, J. H. (1997). The doula: an essential ingredient of childbirth rediscovered. Acta Paediatrica, 86(10), 1034-6.
Raphael, D. (1981). The midwife as doula: a guide to mothering the mother. Journal of Nurse-Midwifery, 26, 13-5.