birth, doula, Honesty, Practice
#WorldDoulaWeek was March 22nd-28th this year, and I asked for questions from friends on social media about doulas, and answered one in a post each day. To close the week, I decided to compile them all in a blog post for your convenience! Bear with me, I wrote these as Instagram captions. Enjoy! Question: “If giving birth in a hospital, does a doula communicate with the medical staff if you have specific wishes for your labor/birth?” Answer: Yes… but not exactly. While many people hire a doula, in part, to serve as their advocate, your doula CANNOT speak on your behalf. However, your doula CAN help you get clear on your labor/birth preferences, and coach you on communicating clearly with your care provider leading up to the birth of your baby. In the hospital, your doula will be by your side to ensure that *informed consent* is upheld. That is, you not only have the space to consent to any care provided, but you also have the time to ask questions and fully understand it in detail before consenting. A tactic that I often use in my practice, to avoid speaking for my client, is to jump in after a care provider offers a medical service and ask them, “hey, your doctor wants to _______, do you have any questions about the benefits/risks/alternatives? Do you want more information about this option before you consent to it? Do you want more time to decide?” It’s magical what a doula can do in a hospital setting to relieve the pressure, provide more space and time to make decisions, and facilitate positive communication with care providers. As Angela Gallo has said, many care providers have a unnecessary tendency towards “rushing and obsessive active management,” on the L&D floor. A doula can help you mitigate that tendency. Question: “Why might I want/need a birth doula if my partner will be there during my labor?” Answer: Your partner and your doula work together – a doula does not replace your partner. As Penny Simkin says in her book The Birth Partner, “Childbirth is intense, demanding, unpredictable, and painful, and it can last for anywhere from a few hours to 24 or more.” Your medical care providers will not be present for the entire duration of your labor, they will be in and out of the room. Having a doula in the room with you, who has gone through this process many times, can help put you at ease. In order to have a positive labor experience, you need to feel safe and supported. A doula can help you maintain that environment, even if your partner has to rest or step away. Your doula can guide you in applying any comfort measures you have learned or practiced, especially in moments of overwhelm. Your doula and your partner can work together to meet your needs and make you more comfortable. Your doula can step up if your partner is exhausted or overwhelmed – remember, they have to take care of a newborn AND you after your baby is born, and they need to be rested too. Even the best, most attentive, most actively engaged partner can be complimented by the support of a doula. Research shows that the birth outcomes of births attended by Doulas were overall more positive/satisfying, and that there were lower rates of c-section, and unplanned interventions I always say, a triangle is the strongest shape… you wouldn’t sit on a stool with only 2 legs… three’s company… ha! Question: “Can you enlist the help of a doula before you are pregnant to guide you/assist you during the conception process?” Answer: Yes! There are many Doulas who are happy to provide this type of support and guidance. Whether this looks like a short email correspondence or phone call where the doula suggests resources, or if it is a more formal and ongoing service relationship depends on your needs and the capacity of the doula. There are practicing fertility Doulas out there, and many Doulas have the basic understanding and willingness to provide these services. You may also have a preexisting relationship with, or know of a doula in your area that you would like to support you – ask them if they are willing and able to do so! That individual could become an integral part of your family building experience – from conception, to pregnancy, to labor, birth, and postpartum – it is great to have a strong relationship with a doula that carries through and helps to integrate these phases of your life. So many people feel isolated and/or stressed as they navigate their own fertility. Having a non-medical professional who can support you through the conception process can be useful in ways that are different from the conversations you might have with friends and family during this time. Doulas are often practitioners of other wellness modalities that you may benefit from during this phase. AND they tend to be connected to many professional, informational, and community resources in your area that you may not know about. Question: “What services do Doulas provide?” Answer: Doulas provide informational, emotional, and physical support. Okay… so what does that look like? It is different for every individual. What makes a good doula good, is they are able to hold space for your unique needs, and adapt their services to support you in the ways that serve you best. Let’s focus on Birth Doulas in this post. A Birth doula provides informational, emotional, and physical support – what that might look like is… meeting with you pre/during pregnancy to help you to research your options and educate yourself so that you can form preferences and make choices about your care… answering your phone calls/emails/texts when you need to talk something through… serving as your advocate and coaching you to be your own best advocate… ensuring that you have the best, safest, most powerful experience you can have… building a toolbox to use in labor to minimize discomfort, maximize progression, maximize the health and happiness of you and your family, and minimize the strain in the 4th trimester and postpartum periods
What might be in that toolbox? Words of affirmation, soothing touch, movement/postures, counter-pressure, meditation/visualization, aromatherapy, music, communication plans, ice packs, heating pads, a shower/tub, a snack, a warm pair of socks, a photo or video… you name it, if you want or need it.
The services that Doulas provide make sure that YOU are in charge of your own care and your own experience. Everyone’s reproductive choices are different, and a doula can help you determine and then actualize what works best for you. Above all other services, a doula holds space.
Question: “What training do Doulas have?//What does it mean to hold space?”
Answer: This is an important two-fer! The training that Doulas receive can vary, because there is not a single training/certifying body for Doulas. Some training programs have been around for decades, others are very new. There are also some individuals that may have stumbled into this work by helping loved ones, and may not immediately or ever identify as Doulas. Some practicing Doulas who went through training may choose to certify, and some may not. The information in this field is always changing and expanding, and staying up to date on the latest research and practices is vital. There are thousands of continued education learning opportunities for Doulas, and thousands of hours that might be spent reading and studying individually. With all of that variation in training, it can be difficult to determine what you should look for when hiring a doula.
One thing that cannot be effectively taught in any training, though, is the ability to hold space. I use this phrase lot so I just want to clarify what I mean. This is a skill that is learned overtime through experience. From @indiebirth “What does holding space mean? Is it as hippie dippy as it sounds? Sitting quietly with someone, providing them emotional support, and getting them food/drinks is a real skill that not everyone is good at. Knowing when to give space and when to be close is an art. Knowing when someone might need a joke, a back rub, and kind word is an art.” Knowing when to just sit and bear witness is an art.
How many of us have experienced a person in the room with us who wasn’t actually present? How many of us have experienced a conversation when the other person isn’t listening at all?
No matter how much training a doula has, no matter how knowledgeable they are about childbirth, pelvic dynamics, fetal positioning, etc… this is – in my opinion – the most important skill a doula needs.
Question: “How do I choose the doula that’s right for me?”
Answer: There are many factors to consider when hiring a doula. Talk to more than one doula, most will offer a free consultation which you can use as you interview a few. You can find area Doulas online, but it’s often better to ask friends for referrals. Remember, once upon a time a person’s doula would likely have been a community member with whom they had a preexisting connection – if you already know a doula, make sure they’re on your list. Remember too, that if you have a partner, it is important for them to get along with your doula as well – if possible, make sure they are present or on the phone during your initial consults.
As you interview doulas… ask about their training, continued study, and experience. Ask about the guiding principles of their practice. Ask why they became a doula. Tell them your concerns and notice how they respond.
As they answer your questions and you begin to get to know them, notice how the conversation feels. Is there a connection? Do they leave space for you to speak? Do they make you feel heard? Are they communicating in a way that is clear and easy for you to understand?
Finally, make sure that their services, availability, and price aligns with your needs. For birth Doulas, how many prenatal meetings do they offer, and how many postpartum – what is the total cost of their services? For postpartum Doulas, fertility doulas, abortion Doulas and more, do they charge hourly and/or have a minimum number of hours? Are there additional services that they offer? Do they have availability to meet with/serve you at the times you need?
Question: “What should you do if you can’t afford a doula?”
Answer: Be honest and talk about it with the doula you’d like to hire! Most of us got into this work because we want to help. I mean, yes, we want to pay our bills too, but service is the driving force. The cost of Doulas can vary a lot based on experience, services, and even the geographic area in which you live. The big commonality within this variation is we all believe that everyone deserves and has the right to these services.
That being said, many Doulas offer sliding scale pricing, based on annual income. Some Doulas even build into their fee a little extra compensation from those who can afford it, so that they can serve others at a much lower rate, or even pro bono.
You might not know if your doula offers these pricing modifications unless you ask! Ask your Doula of choice if they’re open to bartering for services! Check to see if there is a doula Co-op in your area! ( @phillydoulacoop is a great organization in philadelphia helping to make Doulas more accessible)
Everyone deserves to feel supported. Everyone deserves a doula. Don’t let cost stop you.
You can always contact me with additional questions at loveoverfearwellness@gmail.com
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