Let’s have a little doula chat, shall we? You’re pregnant, and as a result, you’ve acquired a whole new vocabulary: baby-wearing, layette, milk-duct, meconium, hybrid-diapers, effacement, linea alba – the list goes on. One word that will become ever-present on your prenatal planet will be this one: “doula”. You’ll hear it from friends, on social media, in your childbirth class, maybe even from your local grocery store check-out staffer. So, because you have an inquiring mind of the prenatal kind (where you HAVE to know everything, but then forget it five minutes later), you are going to investigate the heck out of this doula thing. And we applaud you for that. If you want a solid intro as to why you should hire a labor support doula, please watch Anne’s video.
In short, doulas provide continuous emotional, physical and informational support to women and their partners prenatally, during labor and birth and the postpartum period. Yup, once you call us, we are there for you during labor, birth, at least 1-2 hours after delivery, and then for an in-home postpartum visit. This means that, no matter how long or short your labor is, your doula is at your side. At home, a couple might not need to call their midwife yet, but feel they are ready for extra support. In a birth center or hospital, nurses and care providers are in and out of your room – they have other patients to tend to and must split their time. But a doula is all yours, for rock-around-the-clock support.
The mere presence of a doula – someone well-acquainted with birth and who, therefore, understands normalcy in labor – is worth a close look as you start to think about your upcoming experience.
The statistics are clear. According to a 2012 study of over 15,000 women who participated in 21 randomized controlled trials, “continuous support during labor has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labor and birth” (Hodnett and colleagues 2011).
As a doula, I am sometimes very physically involved. I’ll help a mom get into various, productive positions that help her cope with the sensations of labor, encourage her body to open and her baby to move down. I’ll suggest the use of a birth ball, or birthing stool, or recommend a change of scene. I’ll always have a basin filled with ice water and washcloths at the ready to cool her forehead or neck. I’ll make sure she’s staying hydrated and well-nourished (even if that just translates to sips and nibbles). I’ll use massage techniques and tools to comfort and calm, maybe while her partner holds her (or not, if she needs some personal space at that time in labor). I’ll employ a rebozo (a tightly-knitted scarf popularized by Mexican midwives) to wrap around her belly or shoulders or hips for support, comfort and for loosening the joints, muscle and tissue involved in labor. I carry several essential oils in my doula bag; some are energizing, some are calming, some help with normal labor discomforts. I’ll constantly check in around a mom’s physical temperature, knowing how to instantly cool or warm her before the thermostat or an open window catches up to her body’s immediate demands.
Sometimes a woman requires more from me emotionally. For some, it means that I’m just there, in the room, present as a woman who preserves normalcy in birth, and knows with 100% certainty that this mom has got it going on! For others, it’s the holding of hands, words of encouragement, or guided meditation. I’m there to help a laboring woman feel completely uninhibited. I will go to the greatest lengths to protect her privacy while she does what she needs to do during this most primal and intimate of life events. I’ll put on a white noise app or music or environmental sounds to drown out anything that doesn’t serve her. I know that sensations, needs, preferences and intensity in labor can change on a dime, so I’m there to a assure a woman and her partner that these changes are all part of her body’s and their baby’s choreography. I’m there to remind her — even when the intensity is so great that she starts to think that maybe-this-was-not-a-good-idea-and-is-it-too-late-for-my-money-back-guarantee — that she’s rocking this like a boss, that with every contraction her baby is moving further down, and that maybe it’s just time for us to change things up in some way so that she CAN persevere and bring this baby down and out and into her arms.
One of my most important roles at a birth is to help a woman advocate for herself. Sometimes it’s helpful for her and her partner to run a decision by me so that I can make sure she understands the benefits/risks of whatever test/procedure/ medication is being suggested by a care provider. It’s my responsibility to ensure that she’s asked all of her questions, and that she gets all of her answers
What is not within a doula’s scope of practice? Well, we never make decisions for our clients, because a. we are not medical care providers and b. we aim to empower laboring women. Decision-making is an integral part of that empowerment process, and we want to encourage awareness of options, not take it away. We can’t tell her when to call her midwife or OB, or when to leave for her birth place if she is not delivering at home (though we would make emphatic suggestions if we sensed that things were moving along precipitously!)
And let me sing this part from the rooftops – we never, ever replace a partner – we are there to support him or her, too! We’ll always offer position or massage suggestions with a partner as main support. If he or she needs a break (and a break can only make for a stronger support person!), we are there always so that the laboring woman will never be alone. We encourage partners to make sure they are eating and drinking (not that kind) throughout labor because we know all too well that when a partner goes down, the whole ship can go, too.
What we CAN do is talk with the mom and partner, answer their questions, and help them strategize every step of the way. We hold a safe space for them, and help to keep it as undisturbed as possible, no matter where they may be. We work to help them create and maintain a synergy that we know will ebb and flow throughout labor and birth. We help to establish normalcy during a time filled with unchartered territory. We are there to encourage and to support in a myriad of ways. How that will look for each birth is utterly unpredictable, and that’s the miracle of it all.
Sometimes a woman worries whether her budget will allow her to hire a doula. Most labor support professionals offer payment plans, and others who have been trained though not yet certified will offer care at reduced rates. There are also non-profit organizations in some areas that provide services on a sliding scale – always worth a search.
For more information about professional labor support, visit Childbirth Connection. And to quote a headline from a Detroit newspaper about labor support, “Don’t Dilate Without a Doula”!
Check back for Part 2 of our doula series, when we honor those who support women and families during the Postpartum period…
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