What is a Doula?
Have you come across suggestions to consider hiring a doula for your upcoming birth? Are you wondering who exactly is this person and what does she do?
The word doula (pronounced doo-lah) has its origins from the Greek language meaning “female helper” (okay, technically “slave”, but life and language can evolve, folks). When the natural birth movement emerged in the 1960’s, the word doula was plucked from obscurity to give an official name to women helping other women during the labor and birth process. It is a rather cool name and a lot easier to say than “professional labor support person” or “birth coach” (which someone might confuse with your partner). One word, two syllables. Easy to remember. Perfect!
Since the earliest times as humans, women have helped other women bring their babies into the world. It’s been the standard for hundreds of thousands of years. But when birth shifted from the home to the hospital and subsequently was overseen with modern technology, the gain of help for emergency situations and complications came paired with a number of losses for normal physiologic birth.
Because modern birth happens most often outside of the home and inside an institution, it is very common for many people to never have witnessed or been to a birth - certainly not one that’s been undisturbed by medical technology. One’s only exposure may be the very dramatic (and not accurate by the way) scenes on TV or in the movies.
Have you been to a birth? Have you been around babies? I always ask this on the first day of class. The vast majority of time people shake their heads, no. It’s very rare to have a class member who has been to an actual birth and a positive birth, not just seen some videos on YouTube or Instagram. Most people are not around babies that much, if at all, either. Doctors and nurses who have been in my classes share they have been to a birth, but readily admit they have all been medicalized births full of interventions for their training (that's why they are taking my class!)
Birth then has become somewhat of a secret mystery and knowledgeable support skills by those closest to us have been lost for several generations. In addition, modern life has evolved so that many of us don’t live with or near extended family anymore (and if you do, I’m jealous!) Even though we may love our family and others in our community, those relationships can at times be complicated or difficult. Sometimes those nearest and dearest to us may not have the personality or skills sets needed to be the support we really require during this process of transformation.
Hence, the doula. Doulas can help fill in the gap of crucial support that used to be provided by close female relatives. Doulas are non-medical birth professionals who can provide practical physical, emotional and educational support for the perinatal period (that’s the time around birth: pregnancy, labor/birth, postpartum and breastfeeding). They can help you advocate for yourself with medical personnel and aid in communication. Doulas can be wonderful at helping you clarify your needs and priorities as well as making sure you understand your options. Doulas know about different labor positions and techniques that can help provide comfort to you during the throes of labor contractions.
Most often these special labor support professionals are women who have given birth themselves (although not always) and many have special training to know how to support pregnant and laboring women (meaning they have gone through a certification process and/or continuing education; however, this is not required to put out one’s shingle as a doula). The important thing to note is that a doula is not a medical care provider; this means that they do not check fetal heart tones, give vaginal exams, diagnose conditions or give medical advice. They are not responsible for health care decisions, detecting any health care needs, or for the delivery of the baby. All those medical care responsibilities fall under the domain of your chosen health care provider.
You may be thinking, “Well, what about my doctor or midwife? What about the nurse? Aren’t they going to offer this type of support?” The simple answer is - no. Doctors most often are not on the hospital floor until pushing and definitely not with you for extended periods of time while you labor. They are not going to be your ongoing cheerleader while you are sweating it out and working hard. Labor contractions can take hours and hours; doctors don’t want to be waiting around and losing income (not their fault, just the way the system is wired) while your uterus takes her own sweet time doing her thing. A doctor’s knowledge and tool set is also quite different from a doula. Your health care provider is concerned with the clinical aspects of your care and this is important guardian task. However, there are also essential physical, mental and emotional needs laboring women have which doulas guard over which are also important. It takes teamwork - no one person can do it all.
What about the nurse? Isn’t she (or he) going to do the doula job? Nope. Your nurse is also really busy with clinical aspects of care (especially as the doctor is not there for the majority of the labor process) and most are trained to support medicalized birth, not natural birth. Who your nurse will end up being on your big day will also be a roll of the dice, so you have absolutely no idea about what they think about the birth process and the type of care they feel most comfortable with. Additionally, nurses usually spend only about 30% of the time you are in the hospital in your room. While a nurse can be a wonderful part of the support structure around you, they are not going to be there moment-to-moment for every need you have.
What if you have a midwife? This a more nuanced issue that I’m not going to be able to address in depth, because where are you planning to give birth? Home, free-standing birth center or hospital? Where a midwife practices and where you plan to give birth to your baby makes a huge difference in the type of support that's given, so I’m only going to generalize here. A midwife can offer a lot of emotional support and tend to approach the labor process differently than an OB, but your midwife also needs to focus on clinical care. She must also maintain the watchful eye of the guardian and needs a bit of distance to be able to oversee your and your baby’s care. Your midwife can’t be running around getting things for you and constantly adjusting pillows for your next position and bringing the water bottle up to your lips after every single contraction. You are going to have a lot of needs in labor that you cannot provide for yourself - someone else needs to be there to do this, or your needs just go unmet.
Understand that the process that unfolds when bringing a baby into the world takes incredible physical, mental and emotional resources as well as stamina - it’s all consuming for the laboring mama. Giving birth is a primal experience - one that is designed to take us into a deeper level of consciousness. Physiologic labor takes you to a different place (some call it “labor land”) that is altered from our everyday interactions with the world. Those contractions that happen over and over again moving in waves of sensation become a ritual that allows you to tap into slower brain waves (theta and delta) which can bring you to a transcendent place and primes you to connect with your baby. In order to go there, a sense of safety, both real and perceived, is essential. To relax into this sense of safety, you need people around you who can protect your labor land cocoon and provide moment-to-moment support focused on you so you don’t get distressed and suffer unnecessarily.
A partner or the baby’s father can often be a wonderful source of support. Because this is a major life event, sometimes couples worry that have a doula will displace the father/partner. However, studies show doulas bring out the best in dads and partners - they are not left alone feeling stressed that it’s all on them to provide for every little single detail of support for hours on end. Being the sole support person during labor can be very overwhelming for a lot of partners. They are going through a major transformation, too, in becoming fathers/co-parents and will harbor normal worries and concerns about the two most important people in their lives - mama and baby. Labor and birth can be a very intense experience - one they have never been through before. Because you are the one consumed with laboring, your partner is not going to be able to turn to you for support. Doulas provide a crucial role in also bolstering the partner and helping him/her to be more engaged; a supported partner will be less worried and stressed which is crucial to help the labor to move forward more easily. Doulas can help dads/partners shine in their role.
Doulas work with new parents starting in pregnancy to build a relationship of trust. A doula is like a sherpa or guide on an arduous mountain trek. She helps you know what you need for this journey so you can be more prepared. She can’t do it for you (it’s still your journey after all), but she can guide you along and be by your side on this path. She can make sure that you have the support you need and help you stay motivated.
Doulas can be helpful for birth planned in homes, birth centers or the hospital. They can be especially helpful in hospital births where there is a lack of continuity of care. She is someone with whom you develop a relationship and who will be with you during the whole labor and birth process. A doula will also visit you postpartum to check in on the transition to new family life, to help you with breastfeeding and to process the birth with you. Doulas can provide the support that other village women used to in times past, but since this knowledge and type of support has been eroded in modern times, this birth professional can step in to fill that important role to help you and your baby have a more supported transition to new family life.