What Does A Doula Do?*

As a doula and a nurse I am concerned with the birth of the baby, and with the birth of the mother. Indian mystic Osho says: “The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new.” I totally agree. So how do I support the birth of the mother? Or said another way, what exactly does a doula do? Well, a whole bunch of things, and many of them happen long before anyone is breathing through a contraction. Here is how I typically work with a doula client:

COMPLIMENTARY MEET AND GREET

Main goals: Meet and understand how you would work together

Most important about this meeting is to simply check out the “vibe.” Second to that is to make sure you feel good about the experience and energy your potential doula can bring to your birth.

UNLIMITED PHONE AND EMAIL SUPPORT

Main goals: Continue building a relationship, have a go-to for your questions, keep your doula up-to-date on your pregnancy

I offer unlimited email and phone support to help my clients better navigate their pregnancy and birth. I also ask my clients to contact me within 24 hours of each midwife or ob/gyn appointment with an update. I can help translate medical-speak and am often able to also see potential issues before they arise and then offer suggestions for how to stay on track with your birth goals.

PRENTAL APPOINTMENTS

Main goals: Help mama clarify her desires and goals, explore how the mother, birth partner, and doula will work together, create an early labor plan, make sure everyone’s clear on what happens when labor begins, practice comfort techniques

There is always at least one prenatal appointment and often two. This is when we discuss in detail the mother’s priorities, fears, concerns, and questions, as well as coping and comfort techniques.

We also talk about how I work with the birth partner, as many people mistakenly think that the doula will displace the birth partner. Quite to the contrary, the doula should help increase the birth partner’s confidence and ability to effectively support the laboring mama. In the postpartum I just attended, new father Sam said that for him, “having a doula with us basically freed me up from worrying about all the infinite details that take place before and during labor and allowed me to focus on being present and supportive of Nikki.” That is always my goal.

We also do a number of practical things like go through the labor bag, confirm that the ice pack is actually in the freezer, and make sure the fridge is stocked with labor-friendly food and beverages. Doing these simple little things—and knowing someone else is looking out for them—helps foster a feeling of emotional readiness.

GAME TIME: LABOR!

Main goals: Provide continuous informational, emotional, and physical support so that mama has a happy, healthy birth; remind and guide the birth partner to effectively support the laboring mama

Once early labor really starts kicking in, I remind my client or her birth partner of the early labor plan I helped them create. Most of our early labor contact is over the phone, but as early labor evolves into active labor, I pack my bag, spray on an essential oil blend that supports labor, and hop in a cab to join my client. My labor doula support typically begins at the woman’s home where—for women who choose a hospital birth—she labors until deciding it’s time to transfer to the hospital. By staying at home as long as possible, my clients are able to freely eat and drink, and to move around unencumbered from monitors strapped to their bellies and tethering them to a bed.

During active labor, my job is to remind my clients that their bodies instinctively know how to give birth; to reassure them that what they are experiencing is normal; and to suggest options as needed that may help them cope better, like new positions or things such as massage, breathing techniques, Reiki, or aromatherapy depending on the situation and each mama’s preferences. Given my familiarity with the hospital culture I can often anticipate what’s coming down the pike and may be able to make suggestions that can help prevent unwanted interventions. After Nikki’s birth she said to me, “one of the greatest benefits to working with you was that you managed to stay one step ahead of the hospital staff. Just about every time I worried about getting pitocin, you would come up with a holistic method to encourage labor and fend off excessive interventions.” Having a trained birth professional who can predict and adapt to the provider’s care plan is definitely one of the benefits of working with a doula.

IMMEDIATE POSTPARTUM PERIOD

Main goals: Take first family photos, help with initial breastfeeding, get mama something to eat and drink, reinforce how amazing mama and birth partner were during the birth

Right after the baby is born I try to honor the amazing work my client has just done. At a birth I attended in December, I asked my client Marci who was holding her brand new son, “Are you proud of yourself?” She got an almost mischievous grin on her face, her eyes opened wide, and she let out an, “Oh yeeaaaah.” (Her husband’s mantra at that time was “That was so awesome! That was so awesome!”) Then it has become my custom to get my client her first real food and drink in quite some time. After such hard work, this is always a much-enjoyed reward. Once I get back with the meal I help with the first breastfeeding, after which I say my goodbyes and leave the family to enjoy their first hours together.

POSTPARTUM VISIT

Main goals: Admire the baby, answer questions, and process the birth

This visit is focused on talking about the birth, filling in any blanks, answering questions, admiring the new baby, and bringing closure to the amazing experience we have just shared. In Nikki and Sam’s postpartum we ate Greek salads, reminisced about the birth, discussed breastfeeding, and enjoyed each other’s company and the afterglow of what we experienced together. Nikki shared that her birth was both different than what she had imagined, and also absolutely wonderful. A statement she followed with “and that’s not something I hear a lot of women say.” New papa Sam chimed in that by having a doula they always had a map for what was ahead—even as the road took unexpected turns.

So what difference does all of this kind of support make to a woman’s pregnancy and birth experience? A pretty big one. Here are some of the most significant benefits of continuous labor support:

• Cesarean rate decreased by 50%
• Length of labor decreased by 25%
• Requests for epidurals decreased by 60%
• Use of pitocin decreased by 40%

All of these factors influence postpartum recovery, initial bonding time between mother and baby, and health care costs. Women who have continuous labor support also rate their birth experiences more highly, and have less postpartum depression. The ability to contribute to these positive healthcare outcomes while also supporting a family at a sacred time is an honor and a privilege. So in summary, what a doula does is this: supports women as they become mothers, couples as they become families, and babies as they start their lives.

*The title was inspired by this exchange between Taye Diggs and Jimmy Kimmel: