What's a Doula?
Photo credit: Salt City Birth and Newborn
Remember back to your first birth experience, how excited you felt to be having a baby. You had the nursery all decorated and themed to perfection, the baby showers and miniature clothes made you even that much more excited. Your prenatal visits with your provider were straightforward and brief, but you didn’t have a whole lot of questions, so it was fine. You felt safe to be delivering at the hospital and trusted the hospital staff and your provider to take care of all the details.
Your birthing day arrived, your provider suggested an induction to make sure you didn’t deliver too big of a baby-that sounded alright to you, so you showed up for your induction at 9:00 am excited to have a baby! The hospital staff were friendly and busily asked you 742 questions about your health history, pregnancy, and which arm to put your heplock in. The pitocin started, you don’t feel much for the first few hours and you think, “I got this, birth isn’t so hard”.
As the day progressed so did the intensity of your contractions, but your confidence and ability to manage the pain were going down rapidly, the nurses came in periodically asking if you were ready for an epidural-the only option you knew of for pain relief. Your partner was there, urging you to get the epidural to get out of the pain. You were unsure what to do and what’s happening in your body. Your cervical check revealed that you had dilated to a three-a three?! After all this time/work? The wind is almost completely out of your sails, thinking about getting to a 10 feels so far away. Your provider finally comes to your room and you ask for the epidural. The anaesthesiologist has a hard time getting it in, so your holding still through contractions is the MOST pain you’ve been in in all your life. Finally it’s in and you lay back in your bed and spend the next twelve hours with little movement and slow and steady dilation and progress.
You’re at a loss. What is your body doing? How much longer will labor take? Can you do anything to make things go faster? Is there someone who knows about labor you can talk to? The nurses don’t seem to have a lot of options to get rid of the discomfort in your lower back. When will my provider come back? Your partner is sleeping, they are a good support, but you’re glad they are sleeping, you’ve been at this for 16 hours now. You’re hungry because you haven’t eaten anything since your few bites of eggs this morning, you’re tired from not being able to sleep well and you feel alone, you wish you just had a trusted person to turn to for your questions. You expected the medical staff to lead you along this process, but their focus is primarily on the monitors strapped around your belly.
You finished dilating-FINALLY and begin to push. You’re thinking, it’s almost time to meet my boy! Three hours of pushing later, your provider is threatening a Cesarean unless you can get the strength up to push this baby out. That was motivation enough to gather your strength and push your baby out in two big pushes.
You had a third degree tear, you can’t feel your legs to get up and pee, so they insert a catheter. The epidural is wearing off and your low back is throbbing, your legs are tingling, and you ask the medical staff how soon you can get your catheter out. You just hurt all over, like your body was hit by a truck and you woke up after the fact.
But…
“You have a healthy baby.” So what are you complaining about?
Fast forward a year or so and you’re pregnant with number two. Reflecting on your first birth experience brings up anxiety, fear and a whole lot of questions. But underneath all the unrest is a quiet voice that says, “birth can be better”.
So…
You start doing your homework. You heard the term “doula” and looked into it, it seemed like the perfect solution to a better birth. You found a doula who you trust who reignites your confidence in yourself, your body and the possibility to be an active participant in birthing your baby. Your doula educates you about the midwifery model of care that focuses on your experience as a birthing person as a priority in addition to a healthy baby and healthy mom, as well as what you can do in labor to make it shorter and easier. You research physiological birth and begin to understand the birth process and what your body went through to deliver your firstborn.
Your birthing day arrives, your labor begins at home and progresses quickly. You call your doula, she gives you and your partner ideas and encouragement to manage for the next hour until she arrives. The intensity grows just like last time, but this time you follow your instincts to position your body and breathe through contractions, the pain is manageable. Your doula and midwife guide you through labor and your partner surprises you with the quality of his support this time around.
The intensity of those final contractions to finish dilating is a lot, but you are able to manage it with the coaching from your doula and support from your partner.
Five hours later with only ten minutes of pushing, you are holding your baby girl in the tub and riding the wave of postpartum endorphins.
Two births, two experiences. What made the difference?
Your support. You can do anything with the right support.
Photo credit: Salt City Birth and Newborn
What’s a Birth Doula?
A Birth Doula is a support person with specific skills and training to guide you and provide continuous support through the process of labor and birth. A Birth Doula provides continuous physical, emotional and educational support to you and your partner during labor to improve outcomes, informed choice, and your experience of the birthing process.
Research shows that people who received continuous support of a Doula during labor experienced…
39% decrease in risk of Cesarean birth
15% increase in the chance of spontaneous vaginal birth
31% decrease in the risk of being dissatisfied with your childbirth experience
What’s the difference between a Doula and a Midwife?
A Doula and Midwife each have a scope of practice and serve different roles on the birth team.
They are trained differently and work together to create a positive, healthy experience for you and your partner.
What does a Birth Doula do?
A Doula DOES NOT do clinical or medical tasks, i.e. cervical exams, take blood pressure, check fetal heart tones, rupture membranes (break bag of waters), diagnose medical conditions, give or adjust medication, etc. Your Provider (Midwife, OBGYN) handles this medical/clinical side of birth.
What does a Birth Doula NOT do?
A Doula DOES provide physical, emotional, educational support for you and your partner during labor and birth. They provide guidance, offer suggestions, assist with positioning, relaxation, breathing, and coping techniques during pregnancy and labor. A Doula fosters a positive environment and supports good communication between you and your provider and medical staff, a Doula assists you and your partner to communicate your birth wishes and make informed decisions-a Doula does not speak for you or make decisions about your birth. A Doula also protects your privacy.
In short, a Birth Doula is your PEEP for birth.
Physical Support
Emotional Support
Educational Support
Partner Support
Physical Support
A doula provides physical support during labor. Their focus is to make the birthing person as comfortable as possible during labor while assisting the birthing process to progress efficiently and effectively .
When birthing persons feel cared for and comforted, they can manage their pain better and progress through labor with less intervention.
Physical Tools a Doula uses:
Massage, counter pressure, acupressure.
Movement and position change to keep labor progressive and support optimal fetal positioning throughout labor and/or turn babies in tricky positions.
Provide small comforts of food, water, chapstick, hair ties, cold washcloth to forehead, hot compress to perineum.
Emotional Support
A doula provides consistent emotional support during labor. A hospital setting can be a stressful environment and a doula works to provide a calm environment where birthing persons and partners feel safe. A doula is the member of the birth team who is consistently present (along with the partner) across shift changes with medical staff and Providers in and out of the space tending to other patients.
When birthing persons feel emotionally supported in labor, their cortisol levels are lower and they are able to progress through their labor more quickly, with less pain + intervention and have a higher satisfaction rate.
Emotional Tools a Doula uses:
Affirmations and verbal encouragement.
Knowledge and assurance when things are "normal" and not.
Calming presence and support for birth preferences/wishes.
Supportive language (affirm choices and avoid trigger words).
Educational Support
A doula provides education during the prenatal period as well as throughout labor and birth. They do not replace childbirth education although some doulas are also childbirth educators. Their role is to provide unbiased information about all of your options, then empower you and your partner to make informed choices prenatally as well as throughout the course of labor and birth.
Education Tools a Doula uses:
Visual aids and language so you understand your options, the birth process and answers to your questions.
Safe space to explore questions, concerns and ramifications of various options.
Provide information about how to avoid specific medical interventions and/or optimize your and baby's health.
Knowledge and unbiased support to discuss options from Provider(s) to make informed choice when stakes are high.
Partner Support
A doula DOES NOT replace a partner. A doula's role is to support the partner to know how to support you in labor, actively participate in making informed choices, and have a positive experience. Additionally, a doula may have personal information regarding the partner's physical and mental health and provide support so the partner can take breaks as needed to take care of their own health resulting in a more positive experience for them.
Partner Tools a Doula uses:
Provide skills, Ideas and suggestions for supporting their partner in labor, make them the hero!
Acknowledge their love and support for their partner.
Involve them in the labor/birth process according to their comfort level.
Provide opportunities and encouragement to take breaks to recharge physically, mentally, emotionally.
Are Doulas only for home births? Or natural births?
No! A Doula is an asset to any birth: hospital, birthing center, home birth, elective Cesarean, unmedicated labor and everything in between. A Doula provides support to create a positive experience in the birthing process by educating and supporting you and your partner to make informed choices and feel like you’re in the driver seat of your birth.
Each Doula has their area of expertise, i.e. epidural, cesarean, vbac, natural/unmedicated birth, twins and multiples, gestational diabetes, loss/bereavement, etc.. It’s important to find a Doula who has experience and expertise that matches the kind of birth you want.
How would I hire a Doula and how much do they cost?
For the most part, a Doula is hired independently by you and your partner, some hospitals, birthing centers or Doula agencies provide doula support with their maternity package. However, most commonly, you choose your Doula, just like you choose your Provider. It is customary to interview multiple Doulas (and Providers) to find an appropriate match for you and your birth goals. I recommend interviewing at least three Doulas especially if you’re a first time mom or hiring a Doula for the first time.
Each Doula sets their price, so cost varies depending on who you hire. Birth Doula packages in Utah range from $500-$1500.
When should I hire a Doula?
Earlier is better than later so you have time to establish a relationship of trust and get support through your pregnancy. A good rule of thumb is to hire a Doula in your second trimester (12-24 weeks). However you can hire a Doula when you first become pregnant even before you hire your provider-they will probably have some insight on which providers would be a good fit for you based on your birth goals.
Conclusion
To summarize, a Birth Doula is a support person with specific skills and training to guide you and provide continuous support through the process of labor and birth. Providers are often caring for multiple patients and provide intermittent medical support while your doula provides continuous physical, emotional, educational, and partner support to improve outcomes, informed choice, and your experience of the birthing process.
And here’s the thing, your experience giving birth matters, it is part of your story forever.
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