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FAQ: How will a doula help a woman's birthing experience?

Posted by Lara Salahi  December 16, 2013 06:39 AM

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Tara Poulin.jpg
Tara Poulin, a mother of five, is a certified Birth Doula, a Birth Doula Trainer and founder of Birthing Gently. Her primary interest lies in working with high-risk mothers and planned cesarean sections at Brigham and Women's hospital in Boston. She is also a childbirth educator and teaches classes at various Isis Parenting locations in Massachusetts. 

A birth doula, otherwise known as a labor companion or birth coach, is specifically trained in pregnancy and childbirth. Here are a few commonly asked questions to help you decide whether having a doula present at your delivery is right for you. 

What is a doula, and how does it differ from a midwife?

Birth doulas provide continuous physical, emotional and informational support before, during and just after delivery. A midwife or obstetrician whomever the woman chooses as her primary medical provider would differ from a birth doula in many ways. A birth doula does not provide any medical care. The birth doula recognizes birth as a key life experience that the mother will remember all her life and therefore assists the woman and her partner in preparing for and carrying out their plans for the birth. A birth doula stays by the side of the laboring woman throughout the entire labor (there is no shift change). A birth doula provides an objective viewpoint and assistance to the woman in getting the information she needs to make good decisions. The birth doula also helps facilitate communication between the laboring woman, her partner and clinical care providers. It is hiring a personal trainer for your delivery.

Why would a woman want a doula? 

There are many important reasons why a woman may choose to have a birth doula present at her delivery. Women reach out to our doula practice for many reasons. Most are trying to put the right support in place to achieve a positive birth experience, reduce fear and to have a familiar and educated person present that can help the woman and her partner navigate the medical system and achieve their birth goals. Many choose a birth doula because they have had a previous birth experience that was not ideal or in some cases traumatizing. 

How would a doula help her birthing experience?  

Many women walk through the hospital doors with what I call their “emotional suitcase” they have previous experiences such as abortion, miscarriage, stillbirth or adoption in their past, and these emotions to bubble up in labor; it is here that the doula can really be of huge support to her to navigate through those emotions.  Others choose a doula because they have no support partner and would otherwise labor alone. Many women feel reassured that the birth doula provides prenatal meetings, 24/7 phone support, attendance at the entire birth, and postpartum in home follow up care. The care received from a birth doula is very personal and tailored to each individuals needs. The studies do show that with a birth doulas presence cesarean section, assisted deliveries, medicated deliveries were all lowered. Breastfeeding rates and birth satisfaction overall were higher. They great thing about the birth doula is the expecting mother can choose the doula who best fits her personality; you cannot do that on a labor and delivery floor when you arrive in labor with your providers.

Can women who would like a medicated birth or are scheduled for a c-section still consider having a doula?

Yes, absolutely. I run a high risk doula practice so most of our clients have no other option but to deliver via cesarean section. Birth doulas should provide a nurturing environment and an unbiased approach to the care they are giving to expecting families, no matter what the plan for birth might be (i.e. Natural, Medicated or Cesarean Section).I know for a fact that there is a stereotype of doulas, you know that “all natural, earthy crunchy woman who does all the mysterious birth stuff”. Oh I have heard it all! Laboring women who choose epidurals or narcotic pain medication have not failed in their labor, nor have they failed the birth doula. In fact most women we work with do have epidurals. 

Why might a women who is not in pain need the support? 

Well believe it or not they tend to be more anxious because the pain is no longer and they can overthink the whole process. Including “how am I going to push this baby out”! Depending on the situation the birth doulas role in a medicated birth would provide suggestions of position change within the bed, relaxation techniques, massage, reviewing and reassessing her options and a plan for stage two (pushing). Women who are having a c-section absolutely need the support of a doula, this could be for an emergency or elective c-section. The environment in the operating room is scary and overwhelming to most couples; they often look like a deer in the headlights and are absolutely terrified, many women feel completely disconnected from the birth. The birth doula is able to adapt and provide a calm and supportive environment for the couple while the medical providers are involved with the actually delivery. In the operating room the birth doula can incorporate massage, music, verbal reassurance, a timeline of events and what to expect next, as well as encouragement and suggestions for the partner. Many birth doulas have heard of the new concept of “Family centered cesarean birth”. I have personally had the privilege to support my own clients through a family centered cesarean at Brigham and Women’s Hospital in Boston; several of my colleges at this hospital are on the leading edge of promoting this new concept. Just to give a brief example of the difference between a standard cesarean birth vs family centered cesarean would include using a clear drape as the baby emerges out of the uterus. The mother is positioned in such a way that she can’t actually see the surgical field, but she is able to witness the actual birth, the standard is to typically use a blue surgical drape in which the mother would be unable to see the baby as it is delivered. That is just one example of many differences between the two.

How would a doula’s support differ from loved ones who may be in the delivery room, such a partner?

I speak from thirteen years of experience and as a mother of five. I can tell you that I have seen many partners; mothers, sisters; friends and family members provide exceptional support to the laboring woman. However many do not provide good support or don’t know how to provide the support that the mother actually needs. They don’t know the most updated evidenced based research on many birth practices. They make suggestions or decisions based on fear and pressure, rather than informed decision making. I see so many partners fearful of what they are watching their loved one go through, they don’t realize what they are looking at and hearing are actually very normal processes of the birth experience. A birth doula is there in a different compactly, we are not as emotionally connected to her so we are able to step back and look at the situation more objectively, we know what normal birth is and can reassure the partner and other support people as her progress through each stage and phase. The birth doula encourages the woman to ask questions of her caregiver and know when and what is most important to be asking. Sometimes if you are too emotionally connected to the mother it can cloud your judgment, for example I do not provide doula services to my own family and friends for this reason. I know other doulas that are able to do this with no problems at all. It’s important to recognize that the plan for birth may change at any moment; this means that some individuals she thought would be helpful to her are actually causing more distress. I encourage the mother to speak with all support people in advance to remind them that there may be a point during the labor that she would like them to leave. A true support person with no agenda will have no problem doing so.

What should women look for in a doula? 

Many birth doulas specialize in various areas, such as teens, VBACS, hypnobirthing, high risk, multiplies etc. You may want to search for a doula that best matches your situation and needs. Is it important to you that the doula is trained and certified or are you open to a trained doula who is still seeking certification? Ask what organization she took her training with? I would enquire about her fees and the structure and what that actually includes. I would also ask for references and please check those! Many people think the best doula for them is one that has years of experience, is a woman, and has given birth herself. I can tell you the reality is that it comes down to personality and the connection you and your partner have with her. It will just feel right! Some doulas are warm, fuzzy and soft-spoken; others are more direct and straightforward in their approach. Some of the best doulas I know have never; given birth themselves, some young, other retired and some are male. Many birth doula certifyingorganizations such as DONA International list doulas by state; this is a great way to find a doula in your area. I would ask your provider for recommendations as well. You may also search our practice “Birthing Gently” for a birth doula, we service MA and NYC.

How can women find a good doula?  

I have been running a birth doula practice of volunteer, apprentice and experienced doulas for close to twelve years now and I have many tips. My first suggestion is to interview a minimum of at least three birth doulas, interviews typically take place in your home or in a public place, they generally last one hour. If experience is important to you than ask the doula in advance about her level of birth experience before interviewing with her. 

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lara Salahi is an award-winning multimedia journalist whose specialty is reporting health and medical stories. She has worked in local, network, and cable television, international print, and documentary film. She More »

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