Doulas: The Elusive Creature


Doulas are an elusive breed rarely discussed before one finds themselves pregnant.

The first time a couple meets a Doula maybe when interviewing one. “What do you all do exactly?” I was recently asked “I’ve just been told that if I plan to go natural, I need a Doula.”.

The fact is, that if you are planning to give birth naturally, you do not require a Doula. I can promise you that if you were in the middle of the woods and went into labor, your body would not wait for an epidural, a Doula, or any other chosen comfort measure. What I can share, both on a professional and personal level, is that the right Doula can make the process more empowering for both the Mother and Partner.

I was transferred to hospital care during my birth. This is me in transition with my Doula-Sister Julie & Husband
 
There are two types of Doulas- Childbirth Doulas who tend to Families in the prenatal, birthing and immediate postpartum periods, and Postpartum Doulas who care for Families after the birth. For this post, I’ll be writing about Childbirth Doulas, and discussing my role as one.

Do I have to have a natural birth to benefit from a Doula?
NO WAY! Doulas are supportive of all birthing Women and Partners. We specialize in holding the space of the Family and making the birthing process empowering. Though we cannot speak on behalf of our Clients, Doulas can assist in facilitating communication with Care Providers and empowering Partners to advocate on Mothers behalf. We are also able to discuss evidence based information about interventions so that Clients may make an informed decision.

Women who choose an epidural can benefit from Doulas in many ways. It is beneficial to hold off on having this procedure until further in labor, and Doulas can provide comfort measures during early labor to help alleviate anxiety and stress. Doulas can also work with the Partner to move Mom from side to side and utilize gravity to bring the baby into optimal position for an easier pushing phase.

What do Childbirth Doulas do before the birth?
Childbirth Doulas typically meet with their clients before labor in order to build rapport. As a Doula, I like to get to know my clients so that they feel comfortable with my touch and have practiced comfort measures during a “dry run” so that these practices become familiar. I also feel that it is important to instill a sense of consistency throughout my client’s pregnancy and birthing time. This time provides me with the opportunity to have a base line of where both Mother and Partner are in a relaxed state so that I can better gauge the labor process, and to understand the particular needs of the Mother and any requests that she may have. There are not a set number of times that I meet with clients, and meetings can range from discussing birth plans to attending prenatals to having a night of comfort measure instruction.

When do I call my Doula when I’m in labor?
Don’t be afraid to wake your Doula up! Personally, I prefer to be called whenever the Mother thinks she might be in labor and is ready to share this with me. I have arrived at the homes of my clients early in labor and have and taken a nap on the couch after getting Mom back to sleep.  I have also met Families at the hospital after they have situated themselves. Both are reasonable as long as it is what Mom and the Partner want. A Doula’s job is to be there when they are needed.

     What is my Doulas role at my birth?
      This question varies from Family to Family, and the official DONA definition states:
  • Recognizes birth as a key experience the mother will remember all her life
  • Understands the physiology of birth and the emotional needs of a woman in labor
  • Assists the woman in preparing for and carrying out her plans for birth
  • Stays with the woman throughout the labor
  • Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
  • Facilitates communication between the laboring woman, her partner and her clinical care providers
  • Perceives her role as nurturing and protecting the woman's memory of the birth experience
  • Allows the woman's partner to participate at his/her comfort level
  • A birth doula certified by DONA International is designated by the initials CD(DONA).
Research evidence shows that the quality services of a postpartum doula can ease the transition that comes with the addition of a baby to a family, improve parental satisfaction and reduce the risk of mood disorders.

Personally, I compare my job to being a server at a top restaurant (follow me here, this is when I usually get strange looks). When you go to a  posh restaurant, you never have to ask for you water to be filled, just the right wine will be suggested for your meal, and you’ve had a lovely time but your server has not been obtrusive. A good Doula makes suggestions at the right time, knows when to hang back and empower the Partner, offers the proper comfort measures at the appropriate time and allows the Family to enjoy the process.

How Long Does a Doula Stay at My Birth?
Doulas are your constant in the process, so we stay though the entire birth. I will make sure that my clients are well situated in postpartum and that the breastfeeding relationship has been established?

What kind of postpartum care is provided?
Most Childbirth Doulas will meet with clients at least once to process the birth. Processing the birth and listening to the story with Parents assists Mama in filling in gaps when she was in laborland. Reminiscing about this transformative event can be very empowering or healing.

When should I hire a Doula, Where do I even find one?
The earlier you begin your search the better. The Triangle has many Doulas, and referrals can be found by simply asking friends and care providers or going to www.dona.org for a list of certified Doulas. I would encourage you to begin the interviewing process early so that you have ample time to choose the right fit for you.

What kinds of questions should I ask a Doula?
There is a suggested list of questions on the DONA site, but aside from those, here are some tips
 
Interview as a Couple. It is essential that a Mother and Partner are on board with whom they choose.
 
Follow Your Instincts. Do you feel comfortable with this person? There doesn’t have to be a logical reason for why not, just follow your intuition.
 
Are There Any Reservations? I always tell my clients that if they don’t care for my accent, how I smell, what I am saying, etc, not to hire me as these annoyances will only be magnified in labor. Folks laugh, but it’s true! You do not want the distraction of being irritated with your Doula! (to my knowledge, I have never not been hired due to how I smell!)