…I’m planning on giving birth in the hospital.
When I first started telling people I wanted to become a doula, most of my friends thought that meant I would be a midwife, or at least only working at home births. I do not catch babies but work with your care provider (doctor or midwife) as part of the birth team to provide you physical, emotional and psychological support during your birth. I look forward to working with moms at all types of births – whatever they and their care provider have decided is best for them – and helping them achieve the most positive birth experience within those parameters. There are many techniques we can use within the hospital’s parameters (and have been proven effective) to manage pain, shorten your labor and greatly lessen your chances of interventions such as oxytocin (pitocin), epidural, forceps/vacuum extraction, and cesarean birth. I also strongly believe in teaching evidence-based care and self-advocacy skills so a woman can be an equal part of her birth team to help define the parameters around her birth experience.
Many moms assume that the nurses will act as a role of a doula. Very few hospitals can afford one-to-one nursing care so it is highly likely you will be laboring without a nurse in the room much of the time. Nurses have many jobs to do besides offer you labor support and may offer a suggestion or two if you seem to not be coping well, but usually they leave comfort measures to you and your partner. While the rest of the birth team is focused on your and your baby’s medical needs, a doula is focused solely on your emotional needs. A doula works only for you and is committed to providing continuous support through your entire birth.
…I’m using a midwife (at home or in the hospital) who will support me in labor.
I can see why you might think that having a doula might be redundant. It is true that you will almost always get much more time with a midwife during labor than with an obstetrician. But since midwives and their assistants also have many other duties such as checking vitals, charting and insuring safety for you and the baby during your birth. A doula provides continuous support, never leaving your side (except for maybe a quick potty break), therefore never interrupting the “dance” between the two of you, which could break your focus and take quite a while to regain. Also, many homebirth midwives show up at just the last few hours of birth, leaving it up to you to cope through birth on your own. Hospital birth midwives vary widely on their level of hands-on support. Hiring a doula will ensure labor support for the entire birth. I’d say the best thing to do is ask your midwife how hands-on she is at providing comfort measures, when she plans to arrive at the birth, and then make the decision to hire a doula based on those answers.
…my husband/partner/mother/friend will be my labor coach.
A doula is not a replacement to your partner or other friend or family member, and most women would prefer someone they know and love to be an active member of their birth support team. The role a father or other loved birth partner is irreplaceable. Doulas work with fathers to be an active, effective member of the birth team at their own comfort level. For some women, hearing the words “you are doing so well” sound much different from a doula than from a husband or partner. A doula can focus on the “coaching”, freeing the partner to focus solely on loving emotional support. Or if your partner wants an active role, we can provide him/her with ideas and instruction for comfort measures and help effectively carry them out. A doula can spell an exhausted birth partner to let him/her have a rest, a bathroom break, a bite to eat or simply to step out of the room and regain composure. A doula’s unique position as an educated birth professional not emotionally tied to you can help your partner understand if you get agitated, calm him down in intense situations and explain procedures and normal parts of birth that might be overwhelming to him. Finally no one person can provide both loving hands and words and take pictures, run errands, take notes, make phone calls, etc. I will serve you and your partner in any way you see fit at the time. Studies have shown that partners are remarkably appreciative and thankful of having a doula’s presence once they are interviewed after the birth.
We can’t imagine having a stranger at my birth with us in such an intimate moment.
By the time you are in labor, we will be far from strangers. We’ll meet several times before the birth and will discuss fears, desires and needs, and will build a trusting relationship. In fact, I’ll be the most familiar face (besides your partner, if present) that you will have in the room!
…I’ve taken childbirth classes and feel prepared.
Great job taking childbirth preparation classes! You and your partner are much more prepared for birth because of them. A doula can extend the effectiveness of these classes by answering any questions that come up after class and practicing techniques with you that you have learned (and adding some new ones) before the birth. During labor you might be surprised that labor is different than you expected. It is surprisingly easy to forget all that you learned in childbirth education in the middle of the intensity of labor, and many moms, in hindsight, think of a particular technique they learned in class that might have helped at a certain spot during the birth. A doula can help you remember during the birth, so you don’t regret not trying something after the moment of birth has passed. We also have a huge list of “bag of tricks” in our brains, so if something isn’t working, we can suggest another technique that might. Having a doula at your birth is like having a trusted childbirth educator with you!
…I’ve given birth before so I know what to expect.
As any mom with multiple children can tell you, every birth is different! A doula can help you keep a positive outlook when you approach a time in a birth that mirrored a difficult moment in your previous experience, or help you through a moment in birth you’ve never experienced before.
…I’m planning on having an epidural as soon as possible.
Firstly I should say that although I’ll always teach possible side-effects of epidurals, I am not anti-epidural but pro-choice, and believe that only the laboring person should be in control of choosing how she copes with her pain. In our meetings before the birth, we’ll explore your pain management goals, the reasons you are wanting epidural anesthesia, objectively discuss its pros and cons, and meet your fears of pain head-on. I support your decision to manage your pain in any way you see fit, and if it is an epidural that you want I’ll help you prepare and advocate for it as soon as possible. If your care provider requires a certain objective to be met before you can have an epidural (for instance – dilation to at least four centimeters), I can help you manage your pain until then and shorten this period of time by keeping you relaxed and mobile to increase dilation. While the epidural is placed, I can explain the procedure to you and keep you calm and relaxed so the anesthesiologist can do his/her job well. Often once an epidural is administered, lights go on, conversations start happening and the mother can feel abandoned. I can help maintain a peaceful, meaningful birth space once the epidural is in place. Also, there are situations in which it may be impossible to have the epidural you planned for (fast labor, busy anesthesiologist, medical situation) which can be a scary experience and I can help you cope if that situation finds its way to your birth. Finally I would add that it is always a good idea to keep as much as an open mind about your birth expectations as possible. With a doula’s help, you may be able to go longer without an epidural than you ever imagined, decreasing chances of cesarean or foreceps/vaccuum delivery!
…I’m having a planned cesarean birth.
One of the primary roles of a doula is to help you create a positive memory of your birth, so one could argue that in many cases doulas are especially important during a cesarean birth. Whether your cesarean is planned or not, there are many things a doula can do to support you and your partner. If the cesarean is not planned but at some point during labor is suggested, a doula can help come up with alternatives or ideas you may suggest to your caregiver, and explain risks and benefits and help you formulate questions to that will help you make your decision. Once the decision to proceed with cesarean has been made, the doula can help create a meaningful birth space inside the operating room, help you and your partner relax, and take photos and video (as permitted) so that your partner can focus on comforting you. If the father must leave your side to go to the nursery with the baby the doula can stay and comfort you so you do not feel alone. She can also serve as a go-between to relay information about how the baby is doing back to the mom and how the mom is doing back to the dad in the nursery. I should add that most care providers/hospitals only allow one support person into the operating room during the cesarean, and that of course is almost always the husband/partner. If you feel strongly about having a doula present at your cesarean birth, ask your care provider about that possibility, get written approval, and put it in your birth plan. I’ve been in local operating rooms for both planned and unplanned cesareans.
…this whole doula thing just seems much too hocus-pocus-earthy-mama to me.
Although I’m a little “crunchy on the inside”, I think you’ll be surprised at how mainstream I look, speak and act. I relate well to and am equally comfortable around both crunchy and non-crunchy families; hospital and homebirth settings; obstetricians and midwives. Chances are that no matter which birth experience you choose, I’ll be comfortable in that space and will work hard so the rest of the birth team will be comfortable with me as well. Doing so can help later if issues come up, and it should go a long way in helping create a positive birth experience for you.