What is a Doula?
If you are considering hiring a doula for the birth of your baby, you probably have some idea of what a doula does. But what do you tell your friends, mothers-in-law, and others who ask, "What's a doula?"
Drs. Marshall Klaus and John Kennell, and Phyllis Klaus C.S.W., founders of Doulas of North America along with Penny Simkin and Annie Kennedy, chose the word doula to describe a woman who helps other women. (It is a Greek word for a particular female household servant.) Doulas are trained birth professionals with experience and instinctual knowledge to offer. Simply put, a doula provides continuous emotional, physical, and informational support before, during, and after birth, for the birthing mother and her family. She does not normally do any kind of medical assessments or advising, but educates a family on choices. Advocating consists of advance education and discussion, and helping the mother find her own voice, but not speaking for her. Doulas may be trained and certified or self-taught, or both.
Doulas aren't new. Up until relatively recently, human females all over the world have given birth with the constantly available support of other experienced females. Even with the increased safety of hospital birth and homebirth with trained lay midwives, we must not disregard this important ingredient. We can have both. Some places to learn more about the history of the doula are www.dona.org, The Doula Book by Klaus, Kennell and Klaus (formerly called Mothering the Mother), and many birth websites and books.
Most doulas in our area will meet with you several times in the prenatal period. You will spend some time getting to know each other and she can listen to your needs, wants, fears, and skills. She will make sure your understanding of the labor and birth process match what you desire to know, and make up any difference. She will go over some nonpharmacological pain relief measures, relaxation skills, and things you can do to affect optimal fetal positioning for birth, as well as some practical advice in preparing for breastfeeding and the postpartum period. She will be available to you around the clock for questions and concerns, and will join you in labor when you are ready for help, whether at still at home or in the hospital. She will stay with you throughout your labor. She doesn't change shift, or need to attend to your safety in overt ways, which frees her to help you consistently and calmly as a familiar face and voice, encouraging, suggesting, and reminding of labor positions and comfort measures. She works as a member of your healthcare team. She supports your choices, whatever they might be. She will stay until your baby is born and you are settled in with your baby and family.
Your doula will meet with you once or twice postpartum, to discuss your experience and memories, to look at photos, to see how things are going with you now and offer help with breastfeeding and getting to know your newborn, providing referrals for concerns beyond her scope of practice. In Minnesota, this is usually done for a set fee, anywhere from a volunteer basis by a newer doula seeking experience or for a family of limited means, to $350 - $800 depending on experience and qualifications. Many parents are submitting claims to their insurance companies and having success being reimbursed. We hope they will all cover this important service soon.
What about dads/husbands/partners? Experience has shown that doulas do not "take over" their jobs but enhance their role by modeling behavior, drawing them closer, and assuring them that the processes of birth are normal and desirable. Our society has quickly gone from barring partners from the birth arena, to relying upon them for full support in labor. Neither is a balanced approach. The pain and blood of birth are not the same as pain and blood of injury or illness, but to a loved one inexperienced in birth and feeling alone, this might be difficult to remember or distinguish. Fathers and partners end up being our best advertising!
What about the nurses, doctors and midwives? Isn't this their job? Unlike a nurse or CNM, a doula can come to your house and help you through early labor. Nurses are busy hospital employees. Many would like to support you through your labor, and will when they have the time. Others are not as comfortable with real honest-to-goodness labor as you might think. Nurses must spend a large amount of their time charting, checking, and ensuring your safety. They may not be able to be present at that moment when you really need an experienced voice telling you that you are doing incredible, important work. They are also required to offer you pain medication throughout, whether you desire it or not. Nurses welcome the extra help and hands a doula supplies. Doctors rarely actually spend much time with their patients in labor as long as things are going safely, but arrive towards the end. And doulas love to work as a team with CNM's, who will hopefully be able to do labor support if they too are not too busy. Most doctors, midwives and nurses in the Twin Cities are familiar with the role of the doula. Even at a homebirth, a doula will have an important role.
Studies on doulas have shown improved outcomes in many areas, from reduction in cesarean birth and other surgical procedures, shorter labors and less use of medication, to increased satisfaction with your baby, your relationship, your medical caregivers and your parenting.
Most of all, a doula is willing to be a witness. To witness you at your most vulnerable and your strongest, without judgement. To witness and acknowledge your fears and your needs, without flinching or trying to "solve" your birth. To let you know that you CAN do it, you ARE doing it, and that birth is possible and inevitable. We can't have your baby for you-neither can your doctor, nurse, partner or epidural. We can't assure you a short labor or a perfect outcome. But we can care for you, and leave you knowing you were cared for. We will act at any given time as breathing coaches, massagers, food-gatherers, relationship counselors, tactful phone call screeners…whatever seems to be needed at the moment to allow you to give birth.
When I first became interested in being a doula, I knew that birth is a significant rite of passage for every mother, but I did not realize the profound effect of emotion on labor progress. I soon learned. The initiation of labor and its progress toward birth and bonding are complex hormonal events. Unacknowledged fear, conflict, disempowerment, and loneliness may easily waylay any of its paths and your best-laid plans (or not, and your baby may be born in the car!). The physiological process may not be perfectly understood, but we do know that it is important, life-changing work, and that birth into kindness, love and harmony is the birth of a better future.
Please come to "All About Doulas" held at the beginning of every month in St. Paul, Minneapolis, Bayport, and Maple Grove and sporadically in our other locations (see "Parent Topic Nights" for a schedule), or any other parent topic night, and bring your questions. Other expectant parents will be there, and they may have questions you didn't even know you had. Feel free to bring with you anyone who is interested or who may be attending the birth of your baby.
Copyright 2003 Mary Sanderlin