“bEARTH Doula (n): One who is trained to empower, educate & support women and their families during pregnancy, childbirth and postpartum. Creating safer outcomes while restoring sacredness, honor and dignity to the birthing process.”
I have been a birth doula for many years, and while it's definitely something that seems to be catching fire - with many women seeking out a doula for their birth and/or wanting to become one, I still often get "you're a WHAT-A?!" when people find out what I do. So, what exactly DOES a Doula do?
The Birth Team
Humans are mammals, however, we are unlike any other. We have huge brains and are the only two leggeds amung our kind. This makes the way that we birth different from other animals, and often puts us in the position of needing help when giving birth. Huge brains = big heads and standing upright = a narrow pelvis. It's no wonder that because of this, our babies must be born earlier than other mammal babies and that we sometimes need help doing it. Enter, the birth team.
Doulas are often mistaken for Midwives, or they are considered synonymous but they definitely are not. However, Doulas have been a part of the birth team as long as Midwives have. For as long as birth history has been recorded, women have been attending other women in labor, helping them in any way they can to ease the process of giving birth to their babies. It's only in our very recent human history that birth has been taken out of the home and woman-centered environment and put into the hospital. Therefore, having 'doula' is not a new thing – it's a coming home for birth and how we were intended to do it.
Modern doulas generally work in both home or hospital births and are prepare parents prenatally and then physically, emotionally and informatively support them through their birth experience. They don't do anything medical - and should never stand between parents and their caregivers or make decisions for their client. No vaginal checks, no catching babies, no temps or blood pressures - the doulas role is not a medical one, but it can be just as important. Giving birth is not necessarily a medical event, and, even when it is, it is certainly also still a physical and emotional journey worthy of doula support.
With the exception of unassisted home births, every birth team consists of either a Midwife (Homebirth Midwife or a Certified Nurse Midwife (CNM) which delivers in the hospital) or an Obstetrician (OB) a trained surgeon in Obstetrics & Gynecology. These are the ones responsible for the medical management of care and the safety of you and your baby. If you are having a hospital birth, there will also be a variety of nurses who will interact with you on an as needed basis while you are there. They will communicate your progress and wishes to the OB/CNM who is on call at the time of your birth and decisions will be made regarding your care in this manner.
What's A Doula Got That They Don't Got?
Regardless of whether you have an OB or Midwife, both often will not show up to your birth until close to the second stage of labor or after and most do not provide massage, counter-pressure, Rebozo techniques, etc. like a doula would. From the time parents feel they need support until after their baby is born – their doula has their back. Literally. She fills the gaps in the care that is provided to parents by the medical side of birth, helping navigate the sea of possibilities wherever they choose to give birth. Doulas are trained in a huge variety of options that OB's, Nurses and sometimes even Midwives are not. Comfort measures, encouragement, breathing and visualization techniques, acupressure, aromatherapy, positions to put you in....these are just some of the things that are often utilized by a trained doula to ease and facilitate the process of labor.
A doula in comparrison to a partner, however, is a completely different thing all together. A good doula supports the family as a whole, not just the mother. The partner in any birth scenario is also going through his or her own emotional journey. They are watching someone they love be in pain, they may also be tired from sleepless nights, or, they may be scared of becoming a parent or even of birth itself. Prenatally, a doula will talk with both of you and discover your comfort zones and expectations – she will give your partner practical tools for them to be the support that you will need. Then, when the time comes, she can give suggestions and provide opportunities for the partner to connect with mom. After all, a good doula knows that connection to the one mom loves most is going to help her open up to her baby faster. Partners often want to help – but, they often don't know how when the moment hits them. Even well prepared partners sometimes freeze or feel like they couldn't do anything right in the birth room. And, sometimes, mom really doesn't want to hear or even see the partner. It's not personal, it's just the way it is sometimes. When this happens, the doula can be a bridge between the two.
Many decisions and options are given to parents while giving birth, and it's incredibly difficult to remember why you did or did not want to do this or that because you – and your birth partner - are in what I lovingly call “Laborland”. Your senses and ability to think and process information are altered. Time is warped and you're probably exhausted and distracted by sensations of pain and excitement. Having a trusted doula who is educated on childbirth and knows you, your partner and your birth wishes can be like having a lighthouse guiding you through the fog. For example, let's say your care provider is there offering to break your bag of water and 'see if that helps speed things up', you or your partner might not remember why this is not a good idea – but your doula will and she will gently remind you so you can make an informed decision on the fly.
Doulas are advocates, but, they do not advocate for you - instead they encourage you to advocate for yourself if or when the time to do so comes up. We as doulas must trust that we have provided you with the right information, resources and encouragement prenatally to create the most ideal birth scenario for you. All we can do is gently inform you and then step back and allow you to make your own choices. Doulas are not there to judge, and a good doula will not have an emotional attachment or expectation for your birth. She is simply there to provide the information and then listen to and respect whatever informed decision you make.
Understanding The System
Doulas have a unique perspective because they frequent both home and hospital settings and are there for parents through their entire experience. A doula is going to do whatever she can to help you try absolutely everything before resorting to a medical intervention not because she doesn't see value in medical intervention – but because she knows that this women will need to look back on her birth with a sense that she truly 'tried everything' before needing help, and because she knows that there are real risks presented to both mother and baby with every intervention.
Currently, the local epidural rate in hospital births is around 91% and the cesarean rate still lingers around 31%. This isn't because women can't handle the pain of labor, or because 1 out of 3 women can not give birth to their baby vaginally - it's because natural birth is not the hospital's specialty. In fact, it's rarely even seen. This is why unsupported and/or unprepared parents rarely end up having a natural birth unless they show up close to delivery. It is not that the hospital want every woman to get an epidural or cesarean – it's just what they know. It's simple, really. They offer medical options because they are medically trained.
We are often hired by second or third time parents because they do not want a repeat of a previous birth experience, and we've often heard them say "I just figured they do this all the time, so we just went with it." However, when parent's aren't fully informed or are not given options (or adequate opportunity to even try other options), a cascade of interventions can happen - and does more often than not. And, when birth doesn't go well, women are often left feeling as though their body is a failure, that they are somehow inadequate, some feel violated (and sometimes, they are), and many could face Postpartum Depression as a result. In the worst case scenarios, the interventions actually may have seriously hurt the mother, child or both leaving both parents feeling guilty, depressed and desperate for answers.
Birth matters, and how we birth is more important than we've given it credit for in our recent history.
Choosing The Right Support
An expecting parent begins seeking out their options regarding pregnancy and childbirth usually soon after they find out they are pregnant. Many, especially first time moms, go to the library and/or spend hours on line reading and absorbing everything they can on the subject. They want to know what's going on with their baby and how to best care for their child and their bodies. Thanks to a strong online presence of Birth Doulas and Midwives (and talk of them by other mothers who have had experience with them) as well as the popular movie “The Business Of Being Born” (which I credit for a LOT of our 'awakening' to our current climate regarding birth in the USA), many women will at least come across the word "Doula". Some, usually those who are passionate about being given the best odds of having a natural, vaginal birth with little to no unnecessary intervention will seek one out in their area. A Google search or website such as DoulaMatch.net should help them find a few options. In the West Michigan area, we are blessed to have a wide variety of wonderful doulas to choose from. From there contact is made - usually by phone or email. The process is different for everyone depending on the families needs and the doula that they are working with.
Generally, most doulas are available for a free consultation to meet in person, have questions answered and generally see if the doula and parent(s) are a good match. It's recommended that parents try to meet with as many doulas as they can to better understand the differences between them and how you 'feel' with each one. Hiring a doula isn't only about her resume. You're going to be naked in front of this person, she will be present in the most transformational moment of your life - the 'vibe' she gives you is extremely important. This is such an important part of the process of becoming a parent - connecting with your intuition and finding your voice!
Working With A Doula
Working with a doula generally begins with proper preparation and education, empowering parents with information that would probably not otherwise be given without digging deeply for it.
Generally depending on the needs of the family the doula is working with, you can expect most doulas to provide:
Help creating an in-depth birth plan (while providing current, evidence based information and statistics regarding each of the options regarding yourself and your baby)
Guidence in finding the right health-care provider and birth location
General knowledge and support through the pregnancy
Connection to your local resources & support
Practice in breathing and birthing techniques
Help emotionally and physically prepare you for birth and parenting
On call service 2 weeks before and 2 weeks after your due date (meaning, she plans her whole life around the potential that you may need her in this time)
Complete emotional & physical support through your labor and usually 1-2 hours after birth, often laboring at home for as long as possible and going to the hospital together (for hospital births).
Breastfeeding support and/or resources
These services cost generally anywhere between $400 – 1,000.00+ depending on the doula you choose and the options she has available as many offer a variety of other services like Photography, Henna, Blessing Ways, Placental Encapsulation, etc. as well. Most are open to trade, payment plans or will work on a sliding scale for low-income families. The value of this service, however, is imesurable. Doulas almost never get paid what they are actually worth, but, they are passionate about being accessible to the families of their community. They understand that birth leaves a lasting impression on your life and that it is an opportunity to start a whole life off on a good note.