There are so many blog posts out there about what doulas do and yet it is still somewhat a mystery. When someone asks me what I do, and I know other doulas will be nodding their head in agreement, I want to cringe. The conversation usually goes something like this,

Me: “I am a birth doula”

Nice Stranger: “So what is a doula exactly?”

Me: “we provide emotional, physical and information support to woman during pregnancy, labor and birth.”

Nice stranger: “oh…” (looks strangely at you)

Yah, it is an impossible question to answer in the limited amount of time you are usually given and is too complicated to describe in one or even two sentences. This post is going to get into the nitty gritty of doula work, beyond the benefits (which the stats already prove), and skipping any explanation as to how it’s different then a midwife. I want to dive deeper into what emotional, physical and informational support really means.

According to the article, The History of Midwifery, on Ourbodiesourselves.org, “in 2012 98.6% of all births took place in hospitals, with nearly 92 percent attended by physicians.” According to, CNM/CM-attended Birth Statistics, from the American College of Nurse Midwives, in 2014 this statistic had not changed much and is now still often quoted as only 8% of births being attended by Certified Nurse Midwives in 2019. I state this because it matters. Humans, like animals used to give birth in caves and our mothers, fathers, grandmothers, sisters, brothers, they all witnessed birth. It was part of life and it worked. If it hadn’t, we wouldn’t be here. This evolved into midwives who championed birth. They knew how it worked and helped woman to feel supported and comfortable with the process. Then, there was a shift, in the US in particular, and by the 1930’s midwifery was demonized and birth had almost entirely moved to a hospital setting[1]. Life-saving protocols and management of labor went from being used to help the small number of those who actually needed it to being used for everyone. I won’t even get into the 41% rise of infant mortality because of obstetrical interference in birth once midwives were pushed out between 1915 and 1929 [1] So now it is 2019, unfortunately there is a good argument that obstetrical violence is even worse but I’ll be the first to say some of the methods and management of labor are also absolutely necessary, useful and helpful when needed. Sadly though, because of this overarching management in the process, trust in birth has disappeared. Enter the doula

EMOTIONAL SUPPORT
We bring trust. Trust in yourself, trust in baby, trust in the process and trust in birth. The feeling you have, especially with your first child, of being in the dark about what will happen, how it will happen or even where you will be can be overwhelming. A doula helps you to navigate this. As mentioned above, birth didn’t used to be such a mystery. Nowadays we are wooshed off to a hospital as soon as you feel something. Most of us (unless you work in the birth world) don’t know what labor looks like or how intense it can feel, what it brings out of someone, or how visceral an experience it will be. A doula helps you to prepare for that. During prenatal sessions and conversations while pregnant a doula heightens your (and your partners) awareness of the intensity that labor can bring as well as remind you of what is normal while labor is happening. If labor goes in a direction that was unexpected and not what you foresaw, as it sometimes does, a doula will help to navigate the options and decisions that may surround you.

In a hospital setting women often feel intimated and small. Doulas help to bring confidence in your decisions, making you feel in control and ultimately helping you to feel proud of your birth no matter what direction it turns. In the now unfamiliar land of birth a doula is your emotional guide during pregnancy, labor and birth, much like an athletic trainer is to your muscles and body, a lawyer is to law and justice, or a psychiatrist is to your brain and life emotions.

Birth can be complicated and society has put stigmas on all types of birth; home birth, cesarean birth, medicated, unmedicated and more. They all come with someone somewhere giving some type of judgement. A doula puts this in perspective and reminds you that it isn’t about anyone else. This is your birth, your way, in the way it needed to be done for you and baby. I often tell my clients, if you know that this was the right decision in your heart for you then it was the right decision and the best one for you and baby. Birth is anything but black and white and sometimes we need to hear that over and over again.

PHYSICAL SUPPORT
During pregnancy, I am of the mind, whats not broken don’t fix, however, activities like Spinning Babies[2], chiropractic care and acupuncture are invaluable. So many of us are now sitting in cars commuting, in office chairs all day, or maybe on our feet for over eight hours a day. Our muscles, ligaments and body become imbalanced, stiff, and twisted. Using tools that help get things back in line won’t guarantee an outcome but they can absolutely help put you in the right direction for a smoother birth. Doulas will refer you to those who can help as well as point you in the right direction as to what Spinning Babies movements might be good for you.

During birth movement can be key to a better birth. If you’ve given birth you know labor is intense and sometimes as active labor kicks into gear the thought of moving can be overwhelming. A doula gently suggests the positions that will help as well as gives you motivation and reasoning why to try them. Doulas see signs in the way you labor to help determine what movement will help you manage the intensity in certain areas of your body, or help baby to move. Some movement may be encouraged simply to help you progress faster, to help baby move down the canal and twist its way down your pelvis. This movement could be as easy as walking, lunging or slow dancing, it could be from spinning babies, or done with a rebozo (a Mexican shawl which can be wrapped and tied in different ways to help progress labor, move baby and provide comfort). Doulas also know best how to use tools such as birthing balls and peanut balls and how these tools can be used on a hospital bed (these hospitals beds aren’t pretty or always comfortable but they sure can move in ways we only dream our beds at home could ) Along with helping your body and baby move, movement also helps your mind. It pairs with your emotions and sometimes with music to distract and help you to focus on the hormones and attributes of labor that actually feel good. Yes, you read that right, I said feel good. Movement can help you get out of your own head and allow the labor to do what it’s meant to. Doulas help make that happen.

On the other end of movement as physical support there is physical support which helps the movement take its full effect through your body. Doulas use positioning, counter pressure and massage to help a laboring woman find ways to relax their body. As a doula I have taken massage classes directed for a laboring woman, but even the slightest touch or hand hold will help. Not only do I use massage to help with relaxation but I also encourage and help a partner to use touch as ultimately, they have the most power and bring the most oxytocin through loving energy. It can be hard for a partner to know exactly how to help physically. A doula helps guide this because it’s the partners birth experience too. A laboring woman feels strength through their partners strength and it’s a doula’s job to help facilitate this.

INFORMATIONAL SUPPORT
Information is needed before labor, during labor and after labor. Preparing for birth is the first step. Along with management of labor and birth in hospitals came this wave of tools which were ironically derived as a way to give power to woman so they wouldn’t have to feel what they didn’t always want to feel, things like twilight sleep, epidurals, and narcotics. What these tools ultimately caused however was a shift in power from the laboring women to the providers. Now, what was more convenient for the provider trumped the labor itself bringing unnecessary cesareans and overuse of labor management. What wasn’t being considered and is only now being looked at with a brighter light, was the effect on labor and when and how these labor management tools were being used. Whether or not this has been improved over time is controversial and differs between hospitals and providers. So how do you know who does what where? Talk to a doula. Doulas are floaters. In Massachusetts they work all over the state with all different providers. An experienced doula learns what to expect from who and where and prepares an expectant woman and/or couple for hospital protocols and differing beliefs between providers.

As mentioned above birth is not black and white and during labor the scenarios that push a provider to talk about a plan of action are endless. What is overwhelming about this aspect is that once a provider presents this plan if you don’t know any better than that plan is your only option. A doula helps you to find the power you already have with information. Many births I attend the provider leaves when they see you have a doula after they have presented what they are thinking to allow discussion. You can imagine how much better someone feels about making any decisions knowing their options and having full knowledge about the plan that was presented. It helps everyone, the provider, the laboring woman and ultimately the baby too:) Doulas provide evidenced based information. This is unbiased, nonjudgmental fact based information regarding anything from artificial rupture of the membranes, getting an epidural to eye ointment.

Doulas also help to prepare you about what the protocol of a hospital is surrounding different scenarios. If your water breaks when will they want you to come into the hospital? Will they allow you to come home to labor in the event of an premature rupture of membranes? When pushing do many of the OBs in the practice you are going to practice rimming or coached pushing? At your hospital can you get into a shower with an IV? Will you be pressured into even having an IV if not necessarily needed? These questions seem small but make a big difference in labor and in the outcome of your labor experience. This information does not stop after birth either. Doulas help with breastfeeding, newborn care, babywearing and post birth bodywork referrals as well. Many many many years ago our elders would learn the natural ways of life and teach their children, but things have changed. We don’t have the community and family knowledge we once had. Doulas help fill some of those gaps. Regretfully, we cannot give someone a village, but we can let them know they are heard and give them resources so they know they aren’t alone.

 

So now you know the meaning behind the emotional, physical and informational support of a doula and why we struggle explaining what we do in a simple way. Maybe this explanation can explain why we are all so passionate about what we do and how much thought and purpose goes into the details.

 

 

[1]Rooks, Judith P. “The History of Midwifery.” Our Bodies Ourselves, Our Bodies Ourselves, 30 May 2012, www.ourbodiesourselves.org/book-excerpts/health-article/history-of-midwifery/.
[2]“Spinning Babies® Comfort in Pregnancy and Birth.” Spinning Babies, Maternity House Publishing, 2019, spinningbabies.com/.

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