Doulas: What are they and what are they not?

Dr Berlin’s Informed Pregnancy Podcast – Labor Doulas

Why this podcast?
I’ve been wanting to feature this one ever since Dr Berlin was interviewed about breech birth on Preggie Pals. For that post, click here.
Dr Berlin is, among other things, an award-winning prenatal chiropractor and a doula who also happens to have his own podcast (with rocking’ theme music).

Plus, as a doula, how could I not love a podcast devoted to keeping people informed during their pregnancy?

How does it look?
The Informed Pregnancy Podcast goes back, as far as I can tell, to 2014, so there are more than a few episodes to go back and listen to! Dr Berlin has covered various topics including vaccinations; breech birth, interviews with celebrities (including Ricki Lake), breastfeeding basics, gentle cesareans, postpartum depression and pain relief.

Episodes tend to be around an hour but if you skip the commercial break in the middle you can save yourself a few minutes.

Why this episode?
I was recently in contact with a lovely mum-to-be who I’d had coffee and a chat with a couple of months before. She was pretty sure she wanted to hire me as her doula but her partner had a few doubts about the whole ‘doula thing’.

Even though it is becoming more and more common to enlist the support of a doula, there are many people, both male and female, who are still a little unclear on just what a doula is, what they do and, importantly, what they don’t do.

Finding this episode (and finding out that this couple wanted to work with me) made for one happy doula!

Who should listen to this episode?
Anyone who is thinking of having doula support or anyone who is just curious what this whole doula thing is all about!

The episode
Dr Berlin interviews Anna Paula Markel who left her fashion career and is now an award-winning doula trainer and current president of DONA International (Doulas of North America). Anna conveys so much about birth doulas in this hour-long episode and does it in such a clear, interesting and engaging way that listening was a joy.

Because Anna breaks things down in such a clear way I think I’ll follow her lead. Here goes!

Why do people become doulas?
Anna points out that it’s not for the money!

Seriously though, becoming a doula is usually the result of a very personal experience with birth. Some people will have had a super positive birth and want to support others in having that too while some will have experienced trauma and hope to lower the chance of that happening to other birthing women.

Are all doulas hippies?
Anna shares that seventeen years ago, when she took her doula training, the other doulas in her class did all share a similar style….white, female, long hair, clogs… today, however, doulas really do come in all shapes and sizes and from all cultural backgrounds.

That’s so incredibly important because you need to have a doula with whom you are completely comfortable. I believe that women in labour are at once at their most powerful and their most vulnerable. You need to work with someone you can be completely relaxed with and who you trust.

That’s key.

Do all doulas want their clients to have a natural birth?
This is a tricky one. In general, doulas trust the process of birth and believe in a woman’s power to birth physiologically. They will likely also have knowledge about both the risks and benefits of interventions such as Pitocin, epidurals and cesareans.

Also, doulas are people and everyone has their own preferences, beliefs and biases.

With that being said, the majority of doulas will recognise that whatever choices they have made, or would make, for themselves have nothing whatsoever to do with what is right for their client or with what their client wants.

A doula should be able to support you in whatever choices you make even if that is not a choice they would make for themselves.

Your birth is about you and your family and a good doula will recognise that it is absolutely not about them.

“An old job with a new name”
Women have always supported other women in pregnancy, birth and beyond but now, with the loss of the village type culture in many places, that has been lost and women are more and more isolated.

The origins of the modern doula link back to a research study carried out in South America in the late 1960’s. Various students recorded information about each mother’s birth and how breastfeeding went afterwards.

The researchers noticed that one of their students was consistently recording better results from the women they observed.

They looked further and noted that this researcher was female, had given birth herself and spoke Spanish (I also remember reading that she stayed with the birthing women for the duration of their labour).

Why are those things important?

She spoke the same language so could communicate with the mother during labour. She could ask if the women wanted to change positions, move around, drink something, have her rub their back, tell them they were amazing…..

Being female and having had her own children do not necessarily mean someone will be a good doula and there are definitely great doulas who are not female or do not have children, but in this case it gave her knowledge, empathy and, I can only assume, a sense of calm reassurance that everything was normal.

Thus, the idea of having someone there, with zero medical tasks or responsibilities, was born. That person would be there purely to support the birthing woman in whatever way she could.

What DOES a doula do?
Anna underlines that she is speaking as a representative of DONA International but what she says rings true for the organisation I certified with too.

Anna says that a doula provides both physical and emotional support as well as non-biased, evidence-based information to their clients.

And, we listen.

We don’t give advice, we don’t share our opinions or what we think you should do, we listen and we support you in making informed decisions.

Doulas can also point out where there might be a gap between your expectations and reality. For instance, if you want a natural water birth but are planning to birth at a hospital with a high cesarean rate you might not be off to the best start.

Along the same vein, Anna uses the example of a client planning to have an epidural. A doula will offer to provide you with information about the epidural. She can explain to you the benefits and the risks but also ensure you are aware of all the things that may accompany that epidural.

It is not, as Anna says, simply an injection in your back. It may take time for you to get one and for it to work, you will have a thin tube in your back, continuous fetal monitoring, possibly IV fluids and a catheter.

Again, a good doula should not try to push you toward or away from any particular choice, but they should offer you information so that whatever choice you make, it is an informed one.

Not everyone will want that information, however, and a doula also needs to respect a client’s choice NOT to know.

What DOESN’T a doula do?
A doula has no medical training and cannot perform any medical tasks or give medical advice. I love that Anna points out that this is one of the benefits of a doula rather than a downside.

Why?

Because, with no medical responsibilities, the doula can focus solely on the comfort and emotional needs of the mother and partner without having to worry about any of the other stuff.

A doula ‘mothers the mother’.

A doula does not make decisions for you or speak to caregivers on your behalf.

It is so important that the mother can look back on her birth and feel she was involved in all of the choices that were made. That she is empowered. A doula should never take that power away from a birthing family.

That does not mean she will stand by while a doctor does something she knows you do not want. She just needs to be a little clever in how she does it.

Instead of jumping up and saying “No! Stop! She doesn’t want an episiotomy!” a doula can simply ask the mother if she has any questions about the procedure that is about to be performed so that the family have the chance either to refuse it or to ask for more information.

How do you find a doula?
Most doulas will have a website so online is a great place to start. You can ask friends, care providers or mums in local social media groups for recommendations.

I like that Anna and Dr Berlin encourage you to think about the kind of qualities you want in a doula so you can narrow it down a little. Do you want someone older and more maternal or someone who is closer to your age? Is it important to you whether or not they have their own children or how much experience they have?

What should you ask?
Most doulas will meet with you free of charge, either via Skype or in person, to see if there is a click.
There are loads of questions you can ask from what their package includes and how much it costs, whether they are certified, why they became a doula and how long they have been doing it but Anna says that the most important question to ask is –

“What is your birth philosophy?”

If the doula is against pain medication or will judge you negatively for having any, you should know that.

The most important thing though, more than anything else, is that feeling of connection. Your doula has to be someone you can trust, be totally open with and who you want by your side during a very intimate and emotional time.

Trust your instincts.

What if my partner doesn’t want a doula?
Partners can sometimes feel that they are going to be replaced by the doula. In fact, the opposite is true. A doula can support the partner in supporting the mother.

As I said earlier, it is not about the doula.

Personally, I don’t want my clients looking back at their birth and seeing me. As long as the partner wants to be fully involved (and some don’t) I want them to have the experience together. The teamwork that gets them through the birth is such a great starting point for their life as parents.

A doula can suggest various things for the partner to do to support the mother and during very intense moments she may need both the doula and the partner.

Anna gives a simple example but it speaks volumes. If she notices that the mother is thirsty, instead of giving her a sip of water after each surge, she hands the partner the water and they do it.

That way, when they look back at the birth, the mother remembers the partner doing those small but hugely helpful things for her and the partner feels they were involved and useful.

The doula knows birth and the partner knows the mother so together they make such a strong team!

Plus, labour can be long.

A doula is more than happy to either stay with the mother while the partner goes for a coffee or to go and get them a snack.

Who doesn’t want that?

To wrap up
There’s lots more interesting stuff in this episode, including more details about the roots of DONA and the modern doula movement, when a doula will join you during labour and the role of a doula in a medicated or cesarean birth.

I really hope you’ll listen to this episode when you have some time.

If you are considering doula support or had a doula present at your birth I’d love to hear from you!