What does a doula do?
In broad terms, your doctor or midwife is there to focus on the safety of you and your baby, and your doula is there to focus on your comfort. During the prenatal visit, I will ask about your vision of the perfect birth, and learn what you tend to like, including what kind of touch you are comfortable with, which words are calming and which are off-putting, etc. We will discuss specific activities and positions advantageous for the different stages of your labor. And I will couple what I learn specifically about you with my knowledge of laboring women in general to anticipate and react to your needs when the big day arrives.
Your doula can:
• Teach you many techniques for pain reduction in advance
• Make suggestions for more comfortable positions while you are in labor
• Apply counter-pressure to the right spots on your back and hips as your baby descends (as well as teach your partner how)
• Be an extra pair of hands to spell your partner, get you some water, help out with other children if applicable, and tend to all the other little things that come up
• Calm you with massage, reassuring words, or just wiping your brow
“Reassuring words” doesn’t only mean encouragement – it means at some points you’ll find it reassuring in and of itself (in ways that until labor you never considered) that a person who has experience with birth sees the state you are in and still believes in you.
What doesn’t a doula do?
• Perform clinical tasks, such as blood pressure, fetal heart checks, vaginal exams, or others. She is there to provide only physical comfort and emotional support.
• Make decisions for you. She will help you get the information necessary to make an informed decision. She will also remind you if there is a departure from your birth preferences.
• Speak to the staff on your behalf. She will discuss your concerns with you and suggest options, but you or your partner will speak directly to the clinical staff.
Will my partner feel left out or uninvolved?
In my experience partners feel reassured and comforted by the presence of an experienced support person in the room. Most often I help partners stay more involved, because their tendency could be to retreat if they feel scared, and because I can show your partner more ways to help. The partner’s role is not replaced, it is just different, much the same way that your sister or mother or midwife or doctor could never take the place of your partner.
Can I have a doula if I want pain medication or go a more medicalized route?
Yes. In some cases I am specifically hired to help clients navigate the hospital environment. We will discuss other methods of pain relief prior to your birth, and I will be supportive of whatever decisions you make. If you chose or need an epidural I am still there for you and your partner, to help you process the experience and understand your options, to minimize bright lights and distractions, and to provide the continuous, objective presence that defines the doula’s role. I can lead breath exercises, meditation, or visualization. If that’s not for you, we can chat, I can read stories, I can run an errand, or just stand by while you rest until the next phase of labor when you may need me more again. Doulas are trained to support women and their partners through a variety of birthing situations and outcomes.
What’s there to plan? Women have been doing this for all of history…
The answer may seem obvious if you have already devoted a good deal of time to planning your birth, but if you assume all births are relatively similar, or you think you have no control over birth outcomes, read on. Your birth location is the single biggest factor determining the type of procedures you experience in childbirth in the US. So in fact the choices you make prenatally can have a big impact on birth outcomes. We may be taught that the unpredictability of birth makes it silly for us to plan, but think about how often we plan for things in life that are uncertain. If we wanted to get married outdoors, we are well aware that it may rain that day. With birth too we can make back-up plans while still holding on to our vision of the ideal.I suggest you interview a few different types of care provider – hospital or birth-center based midwives, family practice doctors, home birth midwives, and obstetricians – even if you love your current provider personality-wise (make sure you also jive philosophy-wise), even if they are close to your home (think of other places you are willing to spend time travelling such as your job), and even if you are a little further down the line in your pregnancy. See who answers your questions about safety and pain management best. People spend more time researching a car they’re going to buy, picking a wedding venue, even picking baby clothes, than they do researching the right care provider for their birth. And time and again, women rate their births as the most memorable events of their lives – so how do you want to remember your experience?
Women’s bodies are built for this work, but we’re often laboring under conditions that are markedly different than the women who came before us. If you will most likely be attended with highly technical care, it behooves you to learn about that technology and whether your care-provider’s practice has caught up with the technology research. It also behooves you to learn your rights and ask specific questions about your birth facility’s rules or restrictions, because they may be different than your care provider’s personal beliefs. In particular, “routine” (non-emergency) inductions and episiotomies, being made to labor in anti-gravity positions (ie – flat on your back), and being prevented from eating and drinking in labor are practices that are still very common and not proven to improve birth outcomes – many studies illustrate their harm. Why would you want to give birth in restrictive ways if the medical evidence doesn’t support the need for it?It is not my place, or my wish, to tell you where and how to give birth – in the end I think women are best off being where their gut tells them they would feel the most relaxed, and in ways that reflect our great diversity in general. So it is my sincerest hope that women inform their guts with up-to-date information, and that their own opinions, more than any family member or friend’s pre-conceived notions, become the deciding factor. Birth can be a loaded issue for most anyone who has experience in the matter. Welcome to the world of parenthood – perfect strangers on the street will walk up to you with unsolicited advice, and everyone thinks their choices were best. Perhaps there is no “best” – just the right match for the person. Now is a good time to learn about your perspective on pregnancy, birth, and child-rearing. In the end you might be shocked by what you learn about common and not-so-common care practices. Just know that whatever you come to believe in, you can find a community that supports you.