A doula provides emotional and physical support during labor. A doula does not provide medical support; this is the role of the nurse and doctor or midwife. A birth assistant who provides emotional, physical, and medical support would be called a montrice.
So I don’t check to see how dilated people are. I don’t deliver babies. I try my best not to offer medical advice during labor. A rational and objective frame of mind is necessary to provide medical care and is not very compatible with emotional support. My role is to compliment the care provided by the doctor or midwife and nurse, not to replace them.
What I do, as a doula, during someone’s labor and birth depends entirely on what they want. For those who tell me in advance that they want an unmedicated birth so desperately that they’ll need counselling if they end up with an epidural, I have all sorts of tricks for helping them get through that “I can’t do this anymore!” phase. Some people assume that I might not be a doula for someone who is planning on an epidural. This always strikes me as a strange assumption. If I have a client who knows in advance that she wants medication for pain relief I support that completely. My role is usually less active at medicated births but I am glad to be present and a mom who doesn’t need help breathing still benefits from companionship and a friendly comforting presence.
Here are how things go with most of my clients:
I meet with my client and her husband (or other support person or just her) and discuss their preferences and opinions about their birth. I like to go through a few relaxation and breathing techniques and have them practice a few positions that are helpful for labor. I encourage my clients to eat well and exercise and give each client a free copy of my favorite prenatal exercise DVD.
Labor and Delivery:
I arrive as soon as my client wants my support in labor. Sometimes we labor at home for a while, often they want me to meet them at the hospital. During labor I may hold my client’s hand and breathe with her during contractions. I may offer verbal encouragement or advice about various coping methods. I may massage her hands or feet. I may direct her husband to support her in a specific way. Sometimes I remind the nurses and Dr. about the couple’s birth wishes. I run small errands such as getting the nurse, fetching a glass of water or cup of juice, et cetera. After the birth I offer breastfeeding advice and encouragement if needed. I like to stay with my clients until they transfer over to their post partum room.
I meet with each client a week or two after the birth to talk about the birth experience, and see how things are going. If there are any difficulties or problems I can provide a referral to an appropriate organization or individual.
Does all that make a difference?
You’re going to get a biased opinion here. I had doulas at my births, and I am a doula. I think a doula can be a huge help. Several large studies have been done that randomly assign women to have doulas (or not) when they are admitted to the hospital in labor. Nearly all of these studies show a significant decrease in all interventions (cesarean deliveries, epidurals, other pain medications, episiotomy and forcep deliveries) in the women who have a doula. They show higher breastfeeding success and mothers in the doula group rate their birth experience as being more positive.
DOULA MYTH #1: If I have an epidural then I won’t need a doula, right?
It’s a mistake to view an epidural as the ticket to a pain free birth experience. Sometimes they work out that way, but especially if it’s your first birth, you will be better off if you get your epidural after you’ve reached about 6 cm dilation. You should plan on a few hours of active labor and having some support during that time will be a great help. Some people get to 6 cm without realizing they’re in labor but most people experience several hours of contractions that they need to breathe through before they reach 5 to 6 cm dilation.
Also, sometimes epidurals wear off or only work on one side or “don’t take” quite like they should. Even if your labor is short and easy and an epidural blocks any physical sensation for the last half of it, I think it is calming and beneficial to know you have that support if you need it. And I think the hand and feet massage alone would be worth the entire fee for hiring a doula (But that’s just me. I’ve always appreciated a good massage).
DOULA MYTH #2: If I have a doula my husband will feel left out or our birth experience won’t be as intimate. I want my husband to be my number one support person.
Well, believe me, I don’t want to be at your birth if you don’t want me there. But I think that having a good doula helps the husband to provide better support and be more involved and helpful during labor and delivery. That was certainly true at my own births. And sometimes it is really helpful to have the presence and support of another woman.
At my first birth my doula gave me a little pep talk at one point, basically telling me to snap out of it and not panic and asking me what I was thinking when I was having a contraction. I replied that I was thinking “Aughghgh!” and she firmly directed me to return to my coping techniques and gave me a few additional visualizations to try. This was EXACTLY what I needed at that time, and I COULD NOT have taken that advice from Serge, or any other man. If a man had told me that same helpful advice I would have been indignant, perhaps enraged. “What do YOU know about having A BABY!!!” I could have yelled. But coming from a women who had birthed 8 children and been a doula for years, I appreciated the advice, and held on to it as I would a life preserver.
What’s it cost?
What do you think it should cost to have someone on call for your birth and ready to offer support for however long it takes, be that 4 hours or 36 hours? I’ve known doulas who have charged as low as $250 and doulas who’ve charged as much as $1200 per birth. My rate is $300.