A Simple Guide to Doulas: Everything You Didn’t Know But Should

Doulas Guide You’re moving to a foreign country. Maybe this move was planned, maybe it wasn’t. Thankfully, this new place has guides available to help expats transition to their new home. Your guide shows you all the best spots in town only a native would know. She speaks both languages fluently and translates for you until you understand enough on your own. She teaches you all about the culture and how things work in the new country. She makes sure you have the information you need to avoid danger and as much discomfort as possible. On moving day, she is there all day with you lifting boxes, translating, and walking with you each step of the way. Things may not go as smoothly as you’d hoped, but she knows all the tricks and helps you navigate through anything. She has become your confidant, your cheerleader, your teacher, and your advocate. Well, if you’re pregnant, then the foreign country is pregnancy and birth, and your guide is a doula. 

This is the metaphor I often use to help people understand what doulas are all about.

Contrary to the popular misconception, doulas are not some kind of niche resource for “that kind of mom.” Doulas do it all; from home water births to planned c-sections and everything in between.

We work with first-time parents as well as veteran parents of 12 children. I am frequently hired by second-time parents who had a less than ideal first birth experience. We are trained professionals and tailor our services to fit each expectant family and their unique needs. 

Maybe you’ve seen the statistics that families who hire doulas have shorter labors, lower perception of pain during labor, are 39% less likely to have a c-section, have babies with higher apgar scores, and have an overall more positive view of their birth. And yes, women are less likely to request pain medication with a doula present, but they are certainly free to request medication if they want – without judgment.

The statistics listed above come from randomly controlled studies, meaning the women assigned to have doulas have had varying preferences on birth that mimicked the general population. Dr. John Kennel, a pediatrician and researcher of maternal and child bonding, stated, “ If a doula were a drug, it would be unethical not to use it.” 

But what does a doula actually do?

It is surprising to most people, but most of our work happens before the actual birth. Normally, families hire doulas at the beginning or midway through the pregnancy (although I’ve been hired at 39 weeks multiple times). We are available by phone or email throughout and meet at least twice before the birth to accomplish a few things:

First, we establish a relationship. Birth is an extremely vulnerable moment and parents need to feel 100% comfortable with everyone on their “team”.

Secondly, we work to make sure the client and her doctor or midwife are on the same page. This is where the infamous “birth plan” comes up, although hardly anyone uses those words anymore because of the inaccurate connotation of being able to “plan” anything. A much less catchy, but better description would be “birth communication aid” where we talk about all the different options for every scenario in birth. Oftentimes what parents may have in mind is not what their particular care provider is used to doing. Having these conversations before birth can avoid so much miscommunication and potential trauma on the birthing day.

It’s also really important for the client, her partner, and her doula to know exactly what her goals are as far as pain management. I’m going to use a very different skill set for a client who is happy to use an epidural if she needs it vs. a client who wants to be pushed for an unmedicated birth, knowing that both are fine options.

Another huge part of prenatal visits is providing up-to-date, evidence-based education and filling in any gaps in knowledge of the birthing process. This often includes re-framing negative beliefs that have been imposed by our society’s pessimistic viewpoint of birth. Your body is not a lemon! We try to get to a place where you see birth as a healthy, normal event that your body is perfectly capable of doing. If you are heading in with known complications, the goal is being able to look at them realistically and as positively as possible. 

When the birth day finally arrives, your doula is there, just like the guide, assisting you in your goals. This may be providing comfort measures such as heat, massage, back pressure, and labor position changes, including a specific protocol for women who have chosen an epidural. We also provide emotional support (encouragement, compassion) and informational support (“translating”) all throughout the twists and turns of labor. We encourage you to advocate for yourself when there seems to be a departure from your birth preferences. We are trained in natural techniques to get labor moving again if things stall out, among other troubleshooting “hacks”. Remember, we know all the best spots in town! 

But I’m already having my spouse/partner help me. I don’t want anyone taking their spot.

This is another common misconception. No one can replace the relationship and presence of the person you love most in the world, nor do we want to. For example, your loved one’s touch is going to have ten times the positive impact as that of your doula, but they may not know exactly how to touch in a comforting way during labor. We guide them as well, and always defer to them to perform a comfort measure whenever possible. Instead of diminishing their role, we magnify it. Having another set of expert eyes and hands present can liberate your loved one to just be there for you, without having to figure out every detail on their own. They can get some coffee or or go to the restroom without feeling like they are abandoning you. That in itself is priceless. 

How exactly does someone find a doula?

In Virginia, there are few regulations on who can call themselves a doula. It’s up to you to find a doula who attended a proper training program and stays within their (non-medical) scope of practice. A great place to start is on doulamatch.net where you can find a list of local doulas, view their amount of experience and training, and read past client testimonials.

It’s a good idea to set up interviews with at least three doulas to find the best fit for your family. Don’t be afraid of working with a newer doula, especially if they are part of a larger doula group or have more experienced doulas as their “back-up.” This is a great sign that they are competent and you’ll be benefitting from the knowledge of the more experienced doulas, as well. 

In closing, can you accomplish birth without a doula?

Of course. Just as you can move to a foreign country alone. People do it every day. However, if there is a way to reduce the chaos and miscommunication and lessen the chances of a traumatic experience, isn’t it worth it? This is especially true for women who face even higher stakes in pregnancy and birth. Historically, up until the arrival of hospital-based birth, women have always had “doulas”, although they didn’t have a special name. We, as parents, were never intended to figure it out on our own. You don’t need to. Just hire your “native guide”- a doula!