Thursday, January 23, 2014

Doulas - Who? What? Why?

I had heard of doulas before - but wasn't sure what they were or what they did. I got them confused with midwives and thought it was just someone only women having home births had to help them. Then, I came upon the term again in my reading, which I have done a lot of at this point.

So... what is a doula? A doula is trained to provide emotional and physical support to women during childbirth. Doulas do not perform medical tasks, unlike midwives - some of whom have nursing degrees.  Though I originally associated doulas with homebirths, some sources actually say that it's more important to have a doula for hospital births.

"One of the most valuable things a doula can offer is her ability to navigate and decode standard hospital procedures while pleasantly - but firmly - facilitating positive communication between you and the staff so your desires and decisions are clear. Besides being well versed in the physiology of birth and how to support it, a doula is trained in diplomacy. As she interfaces with hospital staff, you and your partner can get on with the intimate business of birthing."
(Davis & Pascali-Bonaro. Orgasmic Birth)

Care from a doula dramatically reduces interventions, length of labor, c-sections, and pospartum depression. Doulas also help the mother's ability to breastfeed and bond. Some statistics: In doula-supported births... 
  • labors are 25% shorter
  • Cesarean rates are reduced 50%
  • women request 30% less pain medication
  • there are 60% fewer epidurals
(Klaus, Kennell, & Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth)

These stats are from a book published in 1993 - and you can find these exact numbers repeated in many books and on many sites. However, some sites are saying that these numbers are no longer valid as that was 20 years ago and there has been additional research on doulas since then. (One such site here)

If you cannot afford a doula, "a well-prepared friend or relative may do just as well." Research shows that the presence of any woman may make your labor shorter and easier. This may be due to the fact that in stressful circumstances, women seek each others' company (unlike men, who exhibit fight-or-flight behaviors). And, having that company of another woman increases your oxytocin levels and lowers your stress hormone levels.

The rates of doulas varies greatly depending on their experience, training, and location. Some doulas provide additional services, such as lactation consulting, postpartum meetings, and even birth photography. Many new doulas who are completing their certification will provide their services for free.

How do you find a doula? is one good resource for finding birth doulas as well as postpartum doulas. has a nice search function that also lists other service providers (most are doulas that provide additional services such as yoga instruction, acupuncture, massage therapy, and photography to name a few). 

One great resource for other military wives is Operation Special Delivery (OSD). This wonderful program connects military wives with certified doulas that will donate their services. There are some stipulations - the program provides doulas only "for pregnant women whose husbands have been severely injured or who have lost their lives due to the current war on terror, or who will be deployed, or unable to attend the birth due to military reasons."

Once you have decided whether or not to take employ the services of a doula, and have found a few in your area to contact... then you must move to interviewing! I read (somewhere...) and was told by one doula, that you should interview at least 3 doulas. Don't go with the first one you meet. You need to be comfortable with this woman - you will be spending many many hours with her while you are in a stressed and vulnerable state. 

Here are some great questions to ask a doula when interviewing them:
  1. How many births have you attended?
  2. What kind of births have you attended? (water birth, c-section, home birth, hospital birth, etc)
  3. Why did you become a doula?
  4. Are you familiar with my hospital/birthing center and doctor/midwife?
  5. When would you join me during labor?
  6. How long would you stay with me after the birth?
  7. Which labor-coping techniques do you think tend to be most helpful?
  8. How do you feel about the use of pain medication?
  9. Do you have any other women due near the time I am due?
  10. Do you have a backup doula in case you are not available when I go into labor?
  11. Have you ever experienced any tension with family members or medical professionals? If so, how did you handle it?
  12. Do you have any references?
  13. Are there any books you would recommend to expecting couples and new parents?
  14. Are you always on call?/When and how am I able to contact you?
Your doula does not have to share the exact same beliefs as you in regards to pregnancy, labor and birth. You should just feel sure that your chosen doula will support your beliefs and your wishes for your birth and not try to force hers on you.

Questions to ask yourself about a doula:
  1. Do I feel comfortable around this person?
  2. Is she warm, enthusiastic, and knowledgeable?
  3. Does she communicate and listen well?
  4. Will she support my choices or does she have her own agenda?
What I wanted in a doula is someone who is more forceful than I am. I tend to be a bit of a doormat and a pushover at times and I do not want to be swayed away from my birth plan by any medical staff just because I'm stressed and they're telling me I should do something. Having a doula would help me communicate better. They would be able to tell me whether what the medical staff is suggesting is a good idea, what other options I may have, whether it is absolutely vital, etc. 

Unfortunately, in this country, it has become the norm at many hospitals to not necessarily do what is right for the woman, baby, and birthing process, but instead do what is most convenient for the staff and hospital. Many women unfortunately experience a very rushed-feeling and stressed-out labor and birth and many doctors try to push certain interventions and procedures on the laboring mother to keep with a set time-line. Of course, everything has it's place and it's reason, it's just sadly true that most interventions (such as epidurals, c-sections, and pitocin) are being overused. I do not want to be one of the women who looks back on the birth with regret that I was pressured to use some unnecessary procedure or that I was swayed away from my birth plan for convenience. 

Obviously, things do not always go according to plan. So the term "birth plan" is kind of misleading. I know this. I'm not saying I expect everything to go the way I envision. However, barring any real emergencies, I, at this time, am choosing to not have an induction, artificial rupture of membranes, epidural, c-section, continuous fetal monitoring, etc. (I will write posts on all of these things in the future!) And I do not want to lose my head in the throes of labor and give in at the slightest suggestion. Which is why I want a doula. I expect my husband would support me and my wishes, but there is still some question as to whether he will even be here for the birth. So I fully plan to take advantage of the services of a doula - let her fight my battle for me and help me stick to my birth plan!

Hopefully this post has helped give you a better understanding of what a doula is and what they can do for you and your baby!

Of the three doulas I interviewed, I chose the first one that I met with. Her name is Karrie Nesbit and she was fabulous. To find out all that she did for me during the labor and delivery process, check out my boy's birth story!

My sources:
Orgasmic Birth by Elizabeth Davis and Debra Pascali-Bonaro
HypnoBirthing by Marie F. Mongan
Natural Native Doula Services
Doula Diary
Better Birth Network
Operation Special Delivery
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