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 and more in depth discussion as to why you should hire a labor support doula along with the research confirming their huge benefits, please refer to my Natural Birth Secrets book second edition.

In short, doulas fill an essential void in the isolated modern western world separated from communities and villages and extended families….of women who support women during the process of having a baby, as is and has been done throughout history and around the world. If you have a doula like support person, you may not need a doula, but make sure they are super calm around normal birth, supportive and with whom you feel completely at ease and free to be uninhibited, and are in alignment with your decisions to have your baby your way. My favorite quote about doulas is: “If a doula were a drug, it would be unethical not to use it.” John H. Kennell, MD. I see the benefits of doula support so clearly in my almost 30 years of homebirth practice, and they may mean saving a first time mom or VBAC from a stuck labor, exhaustion resulting in hospital transfer - I track my stats and this is what they indicate.

Doulas are now a profession in which they are trained to 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 them, an excellent doula is there for you during labor, birth, at least 1-2 hours after birth, 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 a doula can offer. 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, and they may be pushing interventions that you do not want. But a doula is all yours, for rock-around-the-clock support and advocacy.

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 large 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). And there have been solid research supporting this ever since.

A wonderful doula know when to sometimes be very physically involved, to 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. They know when to suggest the use of a birth ball, or birthing stool, or recommend a change of scene. They know when to have a basin filled with ice water and washcloths at the ready to cool her forehead or neck, to make sure she’s staying hydrated and well-nourished (even if that just translates to sips and nibbles), when to 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). Many have taken extra training like Spinning Babies to help mama change positions to help baby get into an optimal position if needed, or how to 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. Many carry several essential oils in their doula bag; some are energizing, some are calming, some help with normal labor discomforts.  They may 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.

Often a woman requires more emotionally. For some, it means that the doula is 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. They are there to help a laboring woman feel completely uninhibited. A wonderful doula can be a fly on the wall in or out of the room where the mama is laboring, and she 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. They can put on a white noise app or music or environmental sounds to drown out anything that doesn’t serve her. They know labor and that sensations, needs, preferences and intensity in labor can change moment to moment, so they are there to a assure a woman and her partner that these changes are all part of her body’s and their baby’s choreography. They are 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 wave/surge/contraction she is opening and 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 their most important roles at a birth is to help a woman advocate for herself. This is essential especially today in modern medical obstetric care and corporate or government owned hospital institutions that use fear and coercion instead of proper informed consent, and do not respect a mother’s legal right to refuse. Sometimes it’s helpful for her and her partner to run their decision by their doula so that that they can make sure she understands the benefits/risks of whatever test/procedure/intervention/medication is being suggested by a care provider versus alternatives which include doing nothing. It’s their 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?

They are NOT medical providers so they do not do any medical or midwifery care, they do not have such training nor carry that sort of responsibility. They should never make decisions for their clients, because A - they are not medical care providers and B. they aim to empower laboring women themselves. Decision-making is an integral part of that empowerment process, and they want to encourage awareness of options, not take it away.  They can’t tell her when to call her midwife or OB, or when to leave for her birth place if she is not birthing at home (though they could make emphatic suggestions if they sense that things are moving along precipitously!)

And let me sing this part from the rooftops – they never, ever replace a partner – we are there to support them too! They will always offer position or massage suggestions with a partner as main support. If partner needs a break (and a break can only make for a stronger support person!), they are there always so that the laboring woman will never be alone. They encourage partners to make sure they are also eating and drinking and getting some needed rest throughout labor because they know all too well that when a partner goes down, the whole ship can go, too.

What they CAN do is talk with the mom and partner, answer their questions, and help them strategize every step of the way. They hold a safe space for them, and help to keep it as undisturbed as possible, no matter where they may be. They work to help them create and maintain a synergy that will ebb and flow throughout labor and birth. They help to establish normalcy during a time filled with unchartered territory. They 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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