Birth Keepers: The Missing Link

by Christell Antoine BSN Christell Antoine BSN, BSN (New)

Specializes in PACU ICU. Has 13 years experience.

This article defines what a birth keeper is, and their role in centering an expectant mother. I also describe the outcomes of women who have birth keepers when they are giving birth. The importance of partnering with the birth keeper in the hospital setting.

Collaborating with Birth Keepers (doulas) in Your Nursing Practice

Birth Keepers: The Missing Link


There is a broken piece in women's health, but that does not mean we can’t take small steps toward gluing the pieces together.

My solution is not for everyone, but it is a starting point.

Let’s start with the perinatal phase, where women are in the most vulnerable state of their lives and where they need the most continuous support. The solution involves, when applicable, extending the care team to incorporate the birth keeper.

You may be wondering why I am even suggesting this or even wondering what a birth keeper is. Don’t worry; I’ll go over the definition of a birth keeper and the reasons why birth keepers are important in the centering of expectant women. I will also discuss the outcomes of women who have birth keepers. Additionally, I’ll start a discussion of ways nurses can incorporate birth keepers.

Birth Keepers: Role

Birth keepers, better known as doulas, are usually non-medically trained women who help support an expectant mother and her partner in their perinatal and postpartum journey. A more formal definition of a birth keeper is: “. . . a companion who supports a birthing person during labor and birth. [They] are trained to provide continuous, one-on-one care, as well as information, physical support, and emotional support to birthing persons and their partners' “1.

What I really want to highlight in this definition is that this person is giving one-on-one support.

The laboring woman and her partner have someone who can advocate for them and attend to their emotional and physical needs in the absence of a nurse who may have other patients.

Birth keepers can hold space in a different manner because of that one-on-one presence. Giving the mother the attention and centering that is needed to bring a child onto this earth. The birth keepers not only provide emotional support, they also devise a birth plan.

Although birth keepers are not medically trained, they do document the desires of the expectant mother and their partner in what is called a birthing plan.  The plan is devised at the beginning of the birth keeper and her client's relationship. It is a key tool that helps the birth keeper keep track of the journey and better advocate and support a client.

Let’s look at how the numbers play out when women are supported by a birth keeper in their perinatal process.

Birth Keepers: Impact on Outcomes

In our data-driven world, it is hard not to talk about outcomes because this delineates the effectiveness of an action taken. There was a time when continuous support for an expectant woman was the baseline. That’s right, birth keepers are not a “new thing,” but we have deviated from their use with the advent of hospitals.

Dr. Rebecca Dekker1 highlights how the movement from birthing at home to a hospital—where a woman is subjugated to the routines of the institution, intervention, staff who are strangers, with no privacy, and needles—takes away the attention from the birthing mother.

In that movement from home birthing to hospital birthing, we left out the birth keeper, who is an integral part of this process because they are the ones who center or re-center the woman.

Some of the positive outcomes described by Dr. Dekker when a doula is present are as follows:

  • 25% decreased risk of cesarean
  • 8% increase in the likelihood of a spontaneous vaginal birth
  • Shorter labor by 41 minutes
  • 1% decrease in the use of any medications for pain relief
  • 38% decrease in the baby’s risk of low APGAR score
  • And a 31% decrease in the risk of being dissatisfied with the birth experience.

As you can see, a birth keeper's role is invaluable, and the importance of partnership with the labor and delivery nurse to create the centering environment results in better outcomes.

Now, how could a labor and delivery nurse help build this? Well, the answer is in asking the birth keeper for her birthing plan.

Birthing Plan

One of the ways a labor and delivery room nurse can help keep the laboring mother at the center of care is by asking the birth keeper for their birthing plan. I spoke about the birthing plan earlier.

A birthing plan includes things like a basic name and demographic. But then it gets a little more specific, including such things as who the expectant mother wants to be in the room, what positions she wants to spend in the different phases of labor, and much more. It really seeks to set the stage for the star performance. A labor and delivery nurse could help incorporate some, if not all, the requests on the birthing plan. Of course, with consideration of the mother’s and the baby's safety, just in that action, we pull the laboring woman out from the side and bring her to center stage. This sounds considerably basic, but as mentioned before, since birthing has come into the hospital setting, it has lost some of its individualized touch.


Birth keepers are the key to helping keep an expectant mother at the center of the birthing process. The birth keeper's role is important enough that the labor and delivery nurse should extend their partnership to them. This method of collaboration is guaranteed to improve birth outcomes. With this small step, we would get the ball rolling to improve the lives of expectant mothers and their babies.  


1Evidence Based Birth

Impact of Doulas on Healthy Birth Outcomes

Health Connect One

Christell Antoine BSN has 13 years experience as a BSN and specializes in PACU ICU.

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