When To Call Your Doula Into Your Birth

The longest time I have spent in a birth is almost 40 hours. By the time this birth was at it's end I was almost delirious and beginning to impulsively make inappropriate "that's what she said" jokes. These were my friends (who know me well), so that wasn't a huge deal - however, I learned a LOT in that birth and the births following about when it is appropriate to go into a birth to be the most help. The following has become my method and is intended to be informative for both the doula client and the doulas who may be reading this. It has truly helped me do the very best job possible for the clients that I work with.

Part of my job as a doula is to prepare the mother/couple for labor in a way that they can better handle the journey as a whole. If I have done my job properly they won't "need" me until they are nearing the last leg of their labor - when they need a doula's support the most. This is empowering to my clients (because they often get themselves farther than they ever thought they could "on their own") and to me as their doula - because, I get very proud when people use the tools and information that I have given them to make the most of their strength and time in labor. Yes, labor is hard - but you CAN do it. Especially with good advice, good timing and great support. These tips will help clarify when to call and what to do in the meantime.

Plan to labor at home as long as possible.
If you are having a hospital birth, one of the biggest things you can do to lessen your odds of unnecessary intervention is to labor at home for as long as possible. "As long as possible" is different for everyone. Some women tend to deliver very quickly, or know they need antibiotics before giving birth, therefore the timing to go in definitely varies from woman to woman. Overall, you don't want to go until you at least know that this is the real thing and that things are moving along nicely. There is less potential for interruption of labor when given this approach.

Consider calling your doula, then your doctor.
Whenever you think you are in labor or that something might be happening, call your doula. You're not necessarily calling her in to the birth, but, she will be able to provide you with ideas and suggestions over the phone. On top of this, it gives her the heads up that she might be going into a labor that day so she can begin to make any necessary arrangements for work/kids/etc.

You do not need to contact your OB until you are on your way to the hospital. If you do, you might be encouraged to go into the hospital way before you really need to do so. For example, some OB's (and each are different - it's a good to discuss individual policies with your care provider) want you there as soon as contractions are 5 minutes apart - or - as soon as your water breaks. However, depending on the length and intensity of those contractions, or the presence of labor when your water broke has a lot to do with how long you still have to go. If you go into the hospital too early, it can provide an opportunity for a whole slew of potential interventions. Obviously, there are exceptions to this rule - always follow your intuition, but, generally it's a good idea to call your doula first and seek her counsel regarding when to call and why. Even if you do not have a doula, you would generally call your OB when you are on your way into the hospital or if you have a direct question or concern.

A watched pot never boils.
Calling people into your labor too soon can make you feel like a hostess of a party where you are the main event. This can actually prolong your labor significantly. People get performance anxiety, especially if they/you feel like it's taking a long time. When you start to sense that they are tired/hungry, it can feel like a lot of pressure for you to get on with the birth...and you'd like to, too, but the pressure is working against you.

Keep your birth team small, down to only the essential people you WANT there (rather than feel obligated to have there). These people should not have any expectation of when they are going to show up because that is strictly up to YOU. Do yourself a favor and surround yourself with people who make you feel empowered and are generally encouraging and supportive - avoid people who cause you stress. Then, only call them into your birth when you feel like their presence would benefit you....and don't be afraid to send them home or to make an "alone" sanctuary in a bedroom or your bathroom so you can escape.

Ignore labor until you can't ignore it anymore.
Labor can start and stop for days at a time up to weeks before the actual labor process, especially if you are experiencing the dreaded "Prodromal Labor" (or as I like to call it - your labor installment plan, because ultimately, a contraction is a contraction and is still working your body and your cervix). First time parents have the hardest time with this because of the anxiety and excitement that goes along with labor starting - and you are not automatically distracted by the children you already have (and have no previous experience to compare it to). You want to meet your baby, and, by this time you're pretty over being pregnant (usually) and are eager to get the show on the road. The biggest mistake people make is by exerting energy to 'get things going' when they notice contractions start. By ignoring labor and keeping yourself well distracted and RESTED you will go less crazy and be much more able to maintain for the long haul.

There will eventually be a "shift" in labor where ignoring it will not be an option...this is a good thing. THEN you can begin your "work" and start coping and riding the waves of your birth.

Exhaustion is enemy #1 in labor - NOT "PAIN".
In labor (and anytime in life, really), it is not the pain that is your biggest enemy - it is exhaustion. Being exhausted intensifies absolutely everything. Pain, hunger, irritation with people or circumstance around you - all of this seems so much more intense and out of control when you are exhausted. We become toddlers who need a nap - badly. It's harder to work with these clients because they are less willing to move around and do the things that might benefit their labor process and/or ease their pain - and not to mention the pushing phase can be much more difficult for these mothers. Now, this isn't to say we all don't get tired by the end of labor, you can almost count on that - however, this is why what you do in early labor matters most.

Sleep your face off!
Seriously.
Once you think that something is truly going on, do your best to GO TO SLEEP! Believe me - you will thank me come 5am and things are just getting "real". If it's the middle of the day, take a nap (or at least take it very easy) - if it's evening, I usually suggest eating dinner, taking a bath and turning in for the night. You would be amazed how much we can labor in our sleep...and if it's truly labor, it's not going to "stop" because you went to bed. Even if you only get 1-2 hours of sleep, it will greatly benefit you in the long haul.

Some clients purchase a bottle of organic red wine for this occasion to help ease the mind and relax the body to be able to obtain sleep. There is nothing wrong with this. The hospital gives out morphine and sleeping pills to women in labor...wine isn't going to kill you (or your babe). Obviously...moderation is key.

Take it to the limit.
Once things make that "shift" and you can no longer ignore your contractions, you (and your partner) are encouraged to cope with labor using whatever coping techniques you have chosen to use - which hopefully you have been practicing nightly before bed. You will still want to get as far into your labor as possible before calling in your birth team, helping them reserve their strength for when you will need them the most.

Ways to cope.
During this time you have alone (or with your partner), spend time loving yourself and each other. Take long baths or showers, spend time kissing and making love (yes, you can make love during labor if your water has not broken, and it actually helps move things along quite nicely).

You will feel your contraction coming before it's really there - this is the time to take your first deep cleansing breath. Get on top of your contraction before it gets on top of you and ride the wave rather than letting it crash over you. This first deep breath helps you do this. From there, work mentally, from the head down to release any tension in the forehead, jaw, tongue, shoulders and down the spine. Always from top to bottom (because we want baby to move down, not up). If you have a partner, they should be scanning your body for areas of tension and gently bringing your awareness to that place in your body so you can consciously release it. The idea here is to make sure that each area of your body is loose and not taking energy and productivity away from the job your uterus and cervix are trying to do. Allow all the tension to be THERE - not in your face/back/hips. A relaxed face, loose hips and breathing mama tells me that she is allowing herself to open up to the process of birth. This is all you can hope for for any mama.

Hitting a wall.
The whole time you are likely keeping your doula updated through texts and phone calls. At some point, you will hit a wall. Things will pick up speed and become more intense. You will need to listen to your intuition here. Are things simply getting more intense, or are you closing in on giving birth. Often times a doula will listen to a contraction or two over the phone and make a fairly accurate assessment of where you are at through your breathing pattern and any sounds you might be making. She will inform you of this assessment and will then make a suggestion or ask you what you would like to do. Sometimes, more often than not, there are 2-3 walls you will move through in labor. Things may be picking up (which is good), but, maybe a hot shower or a bath will help you get through that and help you 'refocus' from where you are now in labor and allow you to continue coping for awhile longer. Sometimes we just need to readjust to this new level of labor.

Things to watch for
These are signs that you may be closer to transition from the first stage of labor to the second stage of labor (pushing). These are all reasons to begin to consider calling in your team and/or going to the hospital (if you're having a hospital birth).

Shaking - Sometimes when you are nearing the transition phase (from first stage labor to second stage/pushing) you begin to shake and tremble.
Nausea - Along with transition, you may begin to feel nauseous and even begin to vomit or burp a lot.
Pressure - Towards the end of labor you will progressively feel more and more rectal and vaginal pressure as your baby moves further and further down. You may even be convinced that you have to poop (and sometimes, you do), however, it's often times the baby who is making you feel that way. This is a good indication that you are moving towards transition.
Involuntary "pushes" - the "urge to push" everyone talks about can be easily compared to what it's like to vomit. When throwing up, there is no stopping it - it's coming and your stomach is involuntarily retching it up and out of your body. Essentially, this happens with the urge to push your baby out as well. Your abdomen will begin to heave and you may begin to grunt and push along with it. This is definitely time to get where you are going to be to give birth.
"I can't do this anymore" - These are often the "famous last words" of women as they move into transition.

Asking for help is a sign of strength - not weakness!
All of the above is a guideline for helping you achieve the best birth possible and for reserving the strength of your birth team for when you will be at your weakest (and yet, strongest). Ultimately, your doula will come in whenever YOU feel ready for her. We don't want you to wait until you are pushing - but, it's also not a good idea to call her in too early either. Be honest with yourself and listen to your body - when you feel like you need outside support, that is when you call in your doula. Regardless of where you 'think' you are in your labor.

It has become my policy not to offer to come into births anymore (unless I really feel like she is farther into it than even she knows or understands). Not because I don't want to help, but, because I want to empower her to find her voice and use it. As women we are all so comfortable being the caregivers - and often uncomfortable asking for and receiving help from others. However, as a mother you will likely need help from others, which is why I want to make you comfortable with identifying that need and asking for assistance. For you to say "I need help, can you come in now?" is an honest and direct request which will help those around you know when they are needed by you.

Make sure to call your doula - don't leave her hanging!
One of the worst things that can happen to a doula in her profession is to not be called in and left hanging in her "on-call" state. Birth can be crazy, but there is ALWAYS a moment where you can call her and let her know what is going on - even if that is to say that you don't need her to come in or that the baby was just born super quickly. Being on call means she goes to bed early for you, keeps her schedule fairly clear, avoids leaving town, etc...her life revolves around that phone call that could come at any moment. To leave her hanging, then for her to find out much later that you had your baby is one of the worst feelings a doula can be left with. This is why early communication - as soon as you feel like you're having contractions (whether they are no big deal or not) is so important. It doesn't mean you are calling her in, you're keeping her in the loop.

We actually have a clause in our contract for "failure to call in the doula" where our clients are still responsible for 25% of their labor fee. This covers us for our on call period and helps ensure that people will at the very least keep us informed.

What do you think?
If you are a parent, how does this sound to you? Does it make sense to get yourself as far as you can into your labor before calling in the calvary?
If you are a doula, what has your experience been regarding when to go into birth?
Do you feel like preparing parents with practical tools to get them through labor helps them get farther down the road easier?