Why Hire A Doula?

“If a doula were a drug, it would be unethical not to use it.”

John Kennel

Doula (pronounced doo-lah) is a Greek word meaning “women’s servant.” A labor or birth doula is a formally or informally trained support individual who provides a range of support to those who are pregnant, birthing, and postpartum and focuses on them with continuous one-on-one attention during labor.

Doulas have been around in one form or another since the dawn of humankind (even some non-human mammal species have been observed laboring with “birth attendants”). This article adeptly details the history of birth attendant work.

Some birth/labor doulas may choose to refer to themselves as a labor companion, labor support specialist, birth professional, birth/labor assistants, birth coach, birth consultant, or birth keeper.

What I Do Before Birth

  • share resources & information pertaining to you
  • help you formulate your unique Birth Plan
  • assist with questions you may not feel comfortable immediately asking your care provider
  • make referrals to local pregnancy-related resources as needed
  • connect personally with you as a comrade through this journey
  • visit with you during a scheduled prenatal meeting
  • remain on-call 24/7 from 38 weeks of pregnancy onward

What I Do During Birth

Physical Support

  • provide comfort with pain-management techniques of your preference (massage, counter-pressure, etc)
  • assist with water therapy
  • apply hot/cold sensations
  • ensure you are nourished by giving food & drink
  • maintain the birth environment
  • birth pool set-up/clean up
  • suggestions for physical support, in case of virtual services

Emotional Support

  • reassurance
  • praise
  • company
  • encouragement
  • mirroring
  • help you keep perspective
  • …and work through fears & doubts

Informational Support

  • give early labor support via phone (or throughout, in case of virtual services)
  • give reminders to eat & use the bathroom
  • time contractions if desired
  • explain medical procedures & options (not medical advice)
  • suggest beneficial laboring positions (important even with an epidural)
  • …movement ideas
  • …breathing & relaxation

Partner Support

  • assist partner by giving them a break without leaving you unsupported
  • help partner interpret labor progress
  • take non-professional photos as situation allows

Advocacy

  • support without judgment
  • hold space; your agenda is my agenda!
  • facilitate communication between parents & birth team
  • amplify your voice if it isn’t being fairly recognized
  • empower you to ask questions & verbalize your position
  • serve as a witness, providing peace of mind
  • stay aware of intended procedures so parents have opportunity to give informed consent
  • provide a record of events during labor

What I Do After Birth

  • assist with beginning breastfeeding, if needed
  • help explain birth place procedures
  • help you get settled in your recovery room, if at the hospital
  • visit with you during a scheduled postpartum meeting
  • debrief the birth experience with empathy
  • discuss risk factors and/or any concerning symptoms of postpartum mood disorders (100% shame-free; I’ve been there myself)

What I Do NOT Do

  • perform clinical tasks (vaginal exams, fetal heart monitoring, etc.)
  • give medical advice or make diagnoses/prescriptions
  • make decisions for you
  • speak to birth staff on your behalf
  • impose personal preferences upon you
  • usurp the role of your partner (if applicable)
  • attend intentional free-birth (planned unassisted)
  • predict or guarantee any aspects of your birth
  • bear responsibility for your birth’s outcome
  • drive you (client) to the birth location
  • catch your baby
  • in case of virtual services, I do not physically meet you in labor at any point

As a doula, I do not provide medical care and cannot take the place of a midwife, obstetrician, or other clinical worker at a birth. However, I’m knowledgeable about an expansive number of medical aspects that may arise in childbirth, giving you a better shot at making informed decisions.

What The Stats Say

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Via Rebecca Dekker, PhD, RN, APRN, Evidence Based Birth

Partner’s Role in Birth

“My husband (partner) is my left hand and my doula is my right.”

Doulas Making a Difference

“In one landmark study that evaluated the effects of doulas and fathers working together, researchers found that combining a supportive partner and a doula significantly lowered the mother’s risk of Cesarean compared to just having a supportive partner alone. In 2008, McGrath and Kennell randomly assigned 420 first-time mothers to have routine care (including a supportive partner) or care that also included a professional doula whom they met for the first time during labor. […]

The results showed a substantial improvement in outcomes for women who had both a birth partner and a doula, compared to having a birth partner alone. The Cesarean rate for these first-time mothers was 25% in the group with a partner only, and 13.4% in the group with a partner and doula.” – Evidence Based Birth

Doula shoot-17-X2 copy

References

Additional Resources

A Birth Plan Isn’t What You Think It Is

Hard truth time: a “Birth Plan” isn’t really a birth plan.

Many people have already suspected as such, which is why it’s often reframed as “Birth Preferences” or “Birth Wishes,” yet remains in mostly the same format: a description of the ideal birth outcome, and procedures that won’t be accepted.

Your true birth plan involves the preparations you make for labor, birth, and postpartum. It’s about how you choose to assemble your birth team. It’s your understanding of your options and alternatives. It’s your growing comfort in speaking your truth clearly and assertively. It’s your self-care routine, how you’re being supported by others, your focus on learning, your practice of introspection.

Now, in its most beneficial application, a written “Birth Plan” represents who you are in contrast to everyone else who shares your due date. It shows what you’ve contemplated, envisioned, and become educated about for this birth. It’s a point of reference, reminding of your personal information, desires, and hard “No”s.

A Birth Plan is a communication tool, not a magic shield. It shouldn’t replace important conversations that need to happen with your birth team during pregnancy. And it does not speak for you; many people end up frustrated when they find themselves repeating what they’ve listed on the Plan. But it isn’t a stand-in for consent, or lack thereof; remember, a piece of paper comes with no guarantees. It can serve as an important part of manifesting a positive and healthy birth experience — but it cannot be the foundational building block.

A written Birth Plan can:

✔ help determine whether your birth place and provider are compatible with your needs

✔ aid in reminding of your wishes and preferences, especially if birthing in a hospital where you’ll be meeting L&D nurses for the first time

✔ be a good exercise in organizing your thoughts related to birth policies, procedures, and personal needs

✔ be useful in discussions with your partner about birth, so you can get on the same page

✔ illuminate areas you may want to revisit: gaps in preparation, traumas or fears that are asking to be seen, how you’re feeling about your prenatal care, etc.

Brainstorming Tips:

✔ First draft: list all the things. Think big picture. Determine what you feel strongly about, and what you’re neutral about. Then start eliminating. Which options are irrelevant (see more below)? Let ‘em go. Have you included any aspects that are unavoidable or uncontrollable? These deserve a place in conversation with your care provider, but not necessarily on the birth plan.

✔ Giving your L&D nurses / care provider a “list of demands” is unlikely to go over well. Instead, highlight what’s important – what your needs are, how you want to be supported, and anything that will make this experience as positive as possible for you. How can your birth team best help you? Are there any unwelcome modes of assistance they should know about ahead of time? Write down your ideas!

✔ Anything that is standard procedure can be left out (for example, if your birth place encourages eating during labor and you plan to snack throughout, no need to mention it). Same goes for anything irrelevant (for example, if your provider boasts a very low rate of performing episiotomy, you don’t need to write “No Episiotomy”). On the other hand, if there’s anything unique to you, put it on paper! (Let’s say you want your partner to catch the baby, or you request the word “waves” to be spoken in place of “contractions,” or you’d like certain music playing in active labor).  

Side note: If you realize you don’t consent to many of the standard procedures at your birth place, research other options in which you won’t expect a need to frequently say “No.”

✔ Keep your outline solution-focused, not problem-focused. Focus on what you DO want, not on everything you want to avoid. What do you want — and what can help you achieve this? For example, let’s say you want to feel relaxed and at peace, but the thought of medical interventions brings you anxiety. Instead of writing every intervention you can think of in a “No” column, think about what helps you feel relaxed — maybe quiet voices, massage, limited interruptions, music, whatever it might be for you — and write down 2-3 you know you’ll want to try first.

✔ That said… you can absolutely say NO to anything you want. For example: No vaginal exams for you? No explanation needed. Just say no. It’s your body, your baby, your birth, YOUR choice. You can list alternate ways you prefer to get similar information.

Side note: Please do inform your care provider of your wishes during pregnancy though, so you don’t find yourself struggling to be heard in labor. And find out how your provider handles a situation in which you change your mind in labor (let’s say prior to labor you were okay with the idea of vaginal exams, but you decide against it when labor hits. Will they respect your wishes or does it sound like they’ll give you heck over it?).

✔ For the final draft: keep it short, like a single page. If you find yourself “explaining” a lot as you write your birth plan, consider putting those extra words to better use by scheduling a sit-down appointment with your provider ASAP. If you feel the need to emphatically defend the wishes in your plan, think about why that might be. Do you feel your care provider is trustworthy, or have you noticed red flags? Do you feel safe with your birth team, or do you feel thrown off by the inclusion of a particular individual? Do you have specific concerns that haven’t been addressed verbally? Or maybe something else?

✔ If you’re confronted with strong feelings about something triggering or uncomfortable while writing your Birth Plan, this is a great opportunity to acknowledge, take note, and explore further. You may realize what you thought you wanted isn’t what you want after all. Or you may discover a certain fear is no longer so scary – refreshing!

Practical Stuff:

✔ Put your identifying / medical history at the top for ease of access. Include:

  • Your name
  • Partner’s name
  • Names of any attendants (doula, photographer, relative, etc).
  • Due date
  • Date of last menstrual period
  • Blood type
  • Social Security number
  • Insurance type
  • Emergency contact name & phone number

✔ I don’t recommend using icons / symbols / pictures on your Plan because they can be confusing and hard to decipher. Cutesy fonts can be hard to read as well. Sticking to a simple “Yes, Please” and “No, Thank You” column format in a tried-and-true legible font is usually your best bet.

✔ Make a separate plan for your baby in postpartum. A copy can be left on the baby warmer if birthing at a hospital (even if you don’t wish to use the warmer, as this is where the nurses typically arrange the newborn supplies). Here you can include anything pertaining specifically to baby’s care and treatment from birth onward.

✔ A “backup” plan for transfer or cesarean gives some people peace of mind, but causes anxiety and stress for others. This exercise should end up making you feel more confident, not more afraid — so follow your own lead on whether writing a Plan B would be beneficial. Always keep the backup plan separate from your primary plan.

✔ Remember that, in reality, birth is not an inherently “plannable” event. There is only so much that can be controlled about birth (try as some might). How will you surrender and accept the nature of birth as largely unpredictable? The insights that arise from this question will be key to successful birth planning. It’s a process of recognizing what you can control, and taking action – while also discovering the power in releasing the attempt to control that which is simply beyond your command.

Sacred Severance: “Birthday Candle” Cord Burning Ceremony

I made a few different choices for my second birth, one of which was eschewing the cord-cutting tradition. Instead of clamping and cutting J’s umbilical cord we held a sacred severance ceremony, an ancient ritual that involves using flame to slowly burn the cord. It was a beautiful and peaceful few minutes dedicated to J’s final step in the separation from his uterine life.

All photos credited to Stephanie Shirley Photography.

Continue reading “Sacred Severance: “Birthday Candle” Cord Burning Ceremony”

Questions To Ask Your Care Provider in Pregnancy

From before conception to after your baby is born, there will be a multitude of things you’re not so clear about. Naturally you’ll want to turn to your care provider for insights on any issues that arise, or to elaborate upon what you’ve learned elsewhere.

When a policy is announced or enforced, a test or procedure suggested, or a treatment initiated without sufficient information — you need to be asking questions. Lots of them.

Continue reading “Questions To Ask Your Care Provider in Pregnancy”

All About Postpartum Doulas

A PLANNED versus RANDOM recovery can make a world of difference.

Just as we would follow a care plan after a dental procedure or sprained ankle, we should follow a recovery protocol after birth to re-balance nine months’ worth of physical, emotional, and hormonal transformations.

Postpartum assistance is most often needed in the duration of the Fourth Trimester, beginning a few days after birth (or as early as arriving home from the birthing place) to 12 weeks postpartum. Occasionally additional help is desired beyond this timeframe, particularly among families whose changing circumstances manifest later.

During postpartum, you’ll feel happy, sad, hopeful, lonely, open, raw. At some point you may also feel like modern postpartum is not what nature intended.

Continue reading “All About Postpartum Doulas”