Though doulas have gained increasing popularity, there are still many questions around what a doula does and how she works. Below are some commonly asked questions about birth and postpartum doulas.
What is the difference between a midwife and a doula?
This is one of the most common questions I get asked. Many people believe doulas are "like midwives". This confusion is understandable since doulas and midwives often have similar theologies regarding birth, and many midwives will assist as a doula as they train and certify in midwifery. However, a doula is essentially a mother’s maiden. The term, “doula” is an ancient Greek word defining the most important servant in the household who would assist the woman of the house with her childbearing. A doula focuses 100% of her energy toward enabling comfort, relaxation, ease of pain, and peace of mind to the mother. Her only concerns are that of the mother she is assisting. A midwife and her assistants are trained to deliver babies as well as provide medical attention, medication, prenatal testing, etc. She is concerned with the overall well being of the pregnancy, whereas a doula is specifically focused on the mother' s physical comfort and emotional state.
Why would anyone hire a birth doula? Aren’t there nurses at the hospital who do the same thing?
Most American hospitals cannot possibly provide non-stop care for a birthing mother! Hospital policies and staff shortages greatly contribute to this. Nurses have many duties that must be attended to and your presence in their hospital does not make these duties go away. As much as we appreciate nurses, they simply cannot be everywhere at once. They are also trained to provide medical attention and are primarly concerned with the well being of the mother's labor progress. Most nurses today are conditioned to the medical birth. They are most comfortable with laboring women who have epidurals, narcotics, and other medical treatments to reduce the pain of labor. They are not typically comfortable or familiar with what a natural birth looks like or how best to support one. In fact many nurses have never seen a labor progress naturally without any interventions. A certified doula not only has seen many intervention free and natural childbirths, they've also been trained how to avoid the further cascade of interventions if indeed a laboring women requires one.
But my hospital is really great…I’m sure I’ll get the best care possible.
It’s important to feel confident about the place you have chosen to give birth! This is great. However, many women don’t think about some important factors that could frustrate them even in the best of hospitals, for instance:
- There will likely be other women in labor at the same time as you; you will not be the center of attention for anyone except for your doula and birthing partner.
- Hospital staff changes shifts. This means that you may have several nurses or doctors attending to you at the beginning of your hospital stay and then a whole new set of personalities will take over. Some women say that this is the worst part about hospital delivery because they will have bonded to a certain nurse or midwife and then they leave, only to be replaced by someone the mother does not “click” with as well. Who else but your doula will stay at your side no matter how long your labor is?
- Often times the most modern and up to date hospitals really encourage hiring a doula. Studies overwhelmingly support doula-attended births.
My husband/ sister/ mother will be with me, what more can a doula do than my own family?
The people you love and trust the most should absolutely be present if this is something you feel strongly about! I have been to births where only one birthing partner was present and others where several were in attendance! Both options are great depending on the mother’s wishes. However, keep in mind that people in the room have not been trained in labor support. They might be holding your hand and encouraging you, but most mothers need much more than that. Husbands are also wonderful people to share this experience with. It is important for the mother to share this experience with her partner. It's also important to remember that dads/partners are intensely emotionally connected to you and the baby. They are intimately connected to the birth and all it brings! Many dads leave their child's birth feeling that they have disappointed their partner because they were not able to provide the rock solid physical, emotional, and verbal support that their partner had expected from them.
Won’t a doula’s presence diminish that special moment of bonding between my husband and me?
No more than a doctor/midwife or nurse present at your birth. In fact, a doula’s job is to reinforce and guide a father as he works with the mother through labor and childbirth. They encourage the partner to get involved in the pregnancy and the birthing process. A doula's presence often relieves the father of having to think up or remeber what to do. He typically will mimick the doulas techniques. As a result, laboring women are much more satisfied with their partners. Having a doula allows you both to stay focused on what is truly important, the connection between you two and the creation of your new family.
I thought doulas only assisted at home births.
This is a common misconception, likely due to the same confusion that doulas are like midwives. Those doulas on track to becoming midwives are likely to serve in more homebirths due to the nature of their professional paths. However, Doulas support mothers in the decisions they make to create the birth they want. More and more mothers are choosing their homes and birth centers as their ideal location to birth yet the majority of women in American still deliver in hospitals. Doulas work within their client's ideal birthing space- wherever that may be. I personally, served 90% of my clients in the hospital during my first year as a doula (and 80% of those chose all natural, unmedicated births).
They tell me that a doula can help ensure breastfeeding success. I know they can help with the delivery, but how does a doula help with breastfeeding? Isn’t that what a lactation consultant is for? Do they do different things?
Doulas can and do help with breastfeeding, particularly right after the birth. Because the doula is already present, she can be a great person to help you get started. Typically everyone in the birth room, except the doula, has a list of things that they need to do following a birth. Doulas are there during the first hour after birth and can encourage everyone in the room to get Mom and Baby back together as soon as possible. Doulas can help a mother with positioning and getting the baby latched on to the breast.
In addition, a doula will be with you at 2 a.m., but a lactation consultant will not. Doulas typically work with one family at a time, whereas the lactation consultant has a list of mothers to visit when she comes to work in the morning. Lactation consultants usually hold office hours, like 8 a.m. to 4:30 p.m. If you have your baby outside of those times, then you will need to put your name on a list and wait to be seen. Once you get home, a doula can typically come to your home, but a hospital lactation consultant is not likely to do so. Check with independent consultants for home visits. Doulas will refer you to a lactation consultant if a problem arises that she is unable to assist you with.
What is a doula's theology of birth?
Every doula expresses their theology of birth differently, but generally speaking, doulas believe in the woman's capability of making her own decisions before and during birth. We believe birth is a natural process that generally needs no interference, and every woman has the strength in her to complete the task of labor.
My Philosophy of birth
I believe the best birth experiences are the ones where the laboring woman has the control and power over her own birth. Even if things don't go as she planned or initially desired, she should be allowed to make her own decisions and respected as being capable of doing so. However, I also believe that typically the safest birth is the natural, intervention free birth. I feel God has made women uniquely and capable of carrying and delivering babies. I believe women are strong, and being equipped with the knoweldge and understanding of what goes on (and why) with their bodies during labor, they rise to the challenge and are greatly empowered by the experience. This empowerement translates into how they mother, how they relate to their spouse and others, and how they feel about themsleves. It is a very important moment in a woman's life. So while, I support whatever a woman chooses for her birth even if it includes medical interventions, I tend to encourage and educate from a natural birth advocate's postition. I believe in the value of a doula and see it as a separate role in the birth team. I don't have any desire to become a midwife or nurse or doctor. It is not a stepping stone to a "higher" profession for me. This allows me to focus entireley on being the best doula I can be, and not think ahead in how to apply it to a desired future profession. Doulas are very much needed in most birth environments today.
In America's history of birth, there was a period of time when women were put to sleep as labor began, and they awoke with a baby delivered and separated from them. These were called the "twilight years". Today, we'd like to think much has changed. However, we are still battling remenants of the theologies that lead to the twilight births. The most common way to birth today is the epidural (50%) or cesarean birth (32%). This is due to the medicalization of births. There is a philosophy in which our doctors and nurses are emmersed in that suggests all pregnancies are a condition, or illness which requires treatment.
While this medicalized birth may be necessary for a few, routine interventions have been overused and to our detriment . There are no "cookie cutter" births. Women today must become experts at birth before giving birth in order to have the best birth experience possible, otherwise they may end up with a number of unnecessary routine interventions. It is time to educate ourselves, find support, and change the way we experience birth.