All About: Birth Doulas

The term "doula" refers to a birth or life-stage professional who provides four key things to their clients: physical support, emotional support, informational support, and advocacy support.  There are many types of doulas.  Over the next several weeks, I will be talking about the types of doulas specific to pregnancy, labor & delivery, postpartum, and pregnancy loss.  Each week I will focus on a specific type of doula, her role, and the benefits she provides to her clients.

Birth & Labor Doulas: What They Are

A birth or labor doula is a person, generally a woman who has given birth before herself, who has specialized training and experience with supporting women during their birth process.  Birth doulas typically meet with their clients a few times before delivery so that they may get to know the mother and her partner better and to understand what their ideal birth experience would be, however studies have shown that simply having a birth doula present in the delivery room improves outcomes - whether or not the doula and the client have met before.  Birth doulas provide their clients with the three major tiers of doula support during labor: emotional, physical, and informational.  Some even provide advocacy support, depending on their personal views and/or certifying organization.  

What They Do:

Emotional Support

Pregnancy can be a stressful time in a woman's life.  There are so many differing opinions on what is "safe" and "healthy" while growing a person in your womb.  Add hormones, routine tests, conflicting medical advice, and sifting through all of your birth options and its enough to give anyone heartburn.  Birth doulas provide a safe, empathetic space for expecting mothers to vent all of their anxieties and concerns with.  They also give mothers reassurance, letting them know that their feelings are valid and their choices are supported.  During labor, women need a LOT of emotional support - especially if an unmedicated vaginal birth is the goal.  Birth doulas soothe and comfort the mother, letting her know that what she is going through and feeling is normal and that she is doing an amazing job with her labor.  They also support the partner!  Partners need the steady reassurance and guidance of someone who knows that what is happening to the mother, that she is not dying or in imminent danger, and who can calm them so that they are better able to offer their own unique (and much needed!) support to the mother.  Lastly, a woman remembers the emotional experience of every birth she has for the entirety of her life.  A woman who feels supported in her choices and nurtured through her birth experience will likely have positive emotions and memories, regardless of outcome.  A woman who has the "perfect" birth but who felt unsupported will probably have negative thoughts and feelings about her delivery.  Having a doula present increases the likelihood of having an emotionally satisfying birth.  

Physical Support

Mothers need a great deal of physical support during birth, regardless of the method of delivery.  Undisturbed birth, or birth that has no medical interventions whatsoever, requires a great deal of physical support by the use of comfort measures and positional changes.  Women who choose to have pain medication, such as a narcotic or an epidural, need positional changes and support to help gravity continue to play it's role in the delivery process.  Inductions can be extremely physically challenging as the synthetic hormone, Pitocin, can cause intense and unrelenting contractions - the skilled hands of a doula can help provide much needed pain relief!  Lastly, women who deliver via cesarean section are often over-looked when it comes to delivery support and yet they too are giving birth and have all the same needs as any other mother!  Doulas can be with a mother in the OR if the partner is unable to be there for some reason, and then can provide a huge amount of physical support as the mother recovers in the hospital after delivery.  

Informational Support 

Informed consent is the name of the game when it comes to having an empowering birth experience.  Yet how can you possibly be expected to make an informed choice without knowing all of your options?  Doulas bridge the gap between the medical providers and the clients by providing non-biased information about all of the options available to expecting and new parents in the delivery room and immediately postpartum.  During the delivery, if an intervention is suggested the mother and her partner can ask for a minute to talk it over.  In that time, they can ask the doula about the benefits and the risks of the intervention and provide alternative options that could be discussed with the care provider.  A doula will never choose an option for a client or suggest one option is "better" than another.  Their role is to provide the information the client needs to make their own informed choice.  

Advocacy 

The birth doula's role in advocacy can vary greatly based on a doula's certifying organization, training, and business practices so it is important when interviewing doulas to discuss their role and what they can or cannot do for you in terms of advocacy.  Generally speaking a doula cannot speak to a care provider on behalf of their client, especially in a hospital or medicalized setting.  What she can do is remind you of your choices and support you in your decisions, regardless of hospital policies or care giver preferences.  

How To Find A Birth Doula

There are several ways to go about finding the perfect doula for you.  Doulamatch.net is a free searchable database for doulas that allows women to browse doulas serving their zip code.  Doulas post profile information such as number of births attended, specialty trainings, certifications, and client testimonials.  The doulas are also able to update their availability for Estimated Due Dates on their Doulamatch profiles, allowing mothers to narrow down their searches a little faster.  

Most certifying organizations also have online databases available with listings of their doulas by state or zip code.  DONA.org is a great place to start your search!  

Lastly, word of mouth is a fantastic way to find wonderful doulas and other birthworkers in your area.  Natural birth groups, yoga studios, midwives, lactation consultants, and mom groups usually all have a list of doulas that they know and love.  

It is highly recommended that you interview several doulas before making your decision on who you would like to support your labor.  You want a doula that you feel is a good fit for you and that you have a connection with.  Doulas do not take it personally knowing that you are "shopping around".  Great doulas really want their potential clients to interview with other doulas in the area to ensure that the mother is getting the best person for them and their birth.  

Here is a list of questions you may want to ask during your interviews:

1.  How many births have you attended?  
2.  Have you supported a cesarean section delivery?  Were these planned or unplanned?
3.  What trainings and/or certifications do you hold?  
4.  Do you have a back-up doula?  Is it possible to get their website and business information so that we can familiarize ourselves with them prior to my due date?  
5.  How many prenatal appointments will we have together before my delivery?  How many postpartum visits after the baby arrives?  
6.  What is your on-call window for my birth?  
7.  Are you available by text, phone, or e-mail to answer questions prior to my delivery and during my postpartum period?  
8.  What is included with your services?  Are there limits on hours for labor support?  Do you charge an hourly fee after a certain amount of support hours are provided?  
9.  Do you support women who wish to use epidural or narcotic pain relief?