First, let me offer this disclaimer: Nothing in this article should be taken as medical advice. I am a doula – not a nurse or doctor. While I have studied pregnancy and birth extensively and provide evidence-based information only, I speak in generalizations and from anecdotal experience.
Each pregnancy, labor and delivery is different, and there are exceptions to every rule. If you have questions about your specific situation, I’m happy to point you toward birth resources, but I strongly suggest that you consult with your own health provider.
Phew! Got that out of the way! Now on to the good stuff ...
Undeniably, women have been giving birth since the beginning of humankind. It is only in the last 150-ish years that birth has been considered something that requires medical intervention.
For generations upon generations, birth was simply a fact of life — a biological process and a nearly inevitable rite of passage. Pregnancy was natural, and generally not interfered with.
That’s not to say this was always the best thing for women and infants. Women frequently died in childbirth for a variety of reasons, ranging from poor prior health to medical professionals who didn’t wash their hands. 
Modern medicine has incredible benefits, and has saved the lives of many who experience high-risk or complicated births. Still, the U.S. maternal mortality rate is absurdly high compared to other developed nations, and not because of out-of-the ordinary situations or rare conditions.
The American College of Obstetricians and Gynecologists has put out several statements warning about the risk of elective or unnecessary cesarean sections and other medical interventions.
ACOG states that "although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases [...] it is important for health care providers to understand the short-term and long-term tradeoffs between cesarean and vaginal delivery, as well as the safe and appropriate opportunities to prevent overuse of cesarean delivery".
As mentioned in previous articles, the inclusion of doulas who provide continual support to mothers in labor are one of the tools that we are finding helps to prevent C-sections.
Essentially, a HUGE MAJORITY of pregnancies and births in the United States today are completely healthy and “normal,” therefore rendering most medical interventions unnecessary, and in some cases detrimental.
Health outcomes for most mothers and babies are best when we allow nature to take its course, follow the lead of the labor, and utilize powerful medications only when absolutely necessary.
Still, we KNOW that labor is hard work! The presence of a doula will not minimize any of the sensations you experience. If choosing a medicated birth means you will be the most comfortable and confident during your labor, that is the right choice for you.
However, if you would prefer to labor with less medical intervention, doulas can offer you many other forms of pain relief and common-sense strategies to manage the contractions and ideally facilitate a faster, easier birth.
Below are some typical comfort measures or tactics that doulas tend to use:
Nothing makes you feel discomfort like sitting around and THINKING about it. If you stub your toe and then sit and stare at it and think “THIS HURTS,” your toe is going to hurt for a lot longer than if you “walk it off” and distract yourself.
The same is true for contractions. Being up and mobile allows you to shift your weight to become more comfortable, take your mind off of the contractions, and feel productive.
Furthermore, moving helps your baby to move downward in your pelvis, using gravity to your advantage, and keeps your hips open — two physiological choices that speed labor naturally.
Water is a powerful pain reliever. Whether you stand in a shower or sit in a bathtub, being immersed in water helps to relax your muscles, distract your pain-receptor nerves, and relieve the sensation of gravity, giving your body a little break.
Sometimes, this relaxation is exactly what you need in order for your cervix to dilate (open up) another couple centimeters. Or a dark, quiet bath is exactly what you need to rejuvenate mentally and emotionally.
Some providers are hesitant to suggest a bath if your water has already broken due to the chance for infection, but whether it is early or late in your labor, a shower is always a great option.
It’s likely that throughout your pregnancy, getting someone to rub your back or your feet was a great treat. During labor, for many women the same is true and massage helps them to relax, eases their sore muscles, and provides comfort as well as emotional connection.
Usually, laboring women prefer strong, firm strokes (not light butterfly touches). Doulas can also provide (or show a partner how to provide) counter-pressure on certain parts of the body (ex: the lower back and tailbone) that can relieve discomfort.
Many doulas also know various pressure points that can speed labor along or ease the tremors that many women experience during certain stages of their labor naturally.
The position of your body will influence the position of your baby, and therefore impact how quickly the baby descends into your pelvis, passes through your birth canal and exits your vagina.
Your position may also influence how quickly you dilate and how strong you feel during the pushing stage.
Doulas will offer you suggestions on different positions to try, depending on where you are in your labor, how the baby is doing, and where you are feeling discomfort. The bottom line is that the WORST position for you to remain in, is sitting/lying on your back — the way we often see women in the United States typically birthing.
This does nothing to help your birth progress. It is merely the most convenient position for a health provider to examine you in. And THEY aren’t the ones doing all the work!
It may sound hippie-dippy, but I will stand by the statement that your breathing will be the most important tool to utilize throughout your labor and delivery. Long, slow, measured breaths will not only ensure that you and your baby receive enough oxygen, but help you to focus, relax, and compartmentalize each contraction.
Contractions are like waves of squeezing pressure. They swell to a peak and then dissipate. Learning how to breathe through the contractions, knowing that they will only last for a few long breaths and that they are temporary, can make discomfort feel more manageable.
It helps some women to count breaths aloud, tap out a rhythm, or practice a certain ritualized movement. Remember that labor is like a marathon, not a sprint. Training your breath the way an athlete might will give you power that will last longer, greater endurance and increased mental strength.
These are just a few tricks of the trade. Stay tuned for an upcoming article with more information on what a doula can offer and how our services can impact you, your partner (if you have one) and your baby.
Reviewed February 25, 2016
by Michele Blacksberg RN
Edited by Jody Smith
 “Maternal Mortality in the Past and its Relevance to Developing Countries Today.” American Journal of Clinical Nutrition. Website accessed Feb 21, 2016.
 "Short and Long Term Outcomes After Cesarean Section" Expert Review of Obstetrics and Gynecology. Medscape. Website Accessed 2/24/16.
 "Continuous Support for Women During Childbirth (Review)." The Cochrane Collaboration. John Wiley & Sons. Website accessed Feb 24, 2016.