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She just looked like a doula.

First impressions are a big factor when choosing a doula.  An open demeanor, honest smile and a great lavender-smelling hug often describe a doula.  She is probably someone you will want as a friend or even wish as your mother.  Aside from being affable, a doula needs no skills beyond soft eyes and the ability to take pride in putting a straw to a woman’s lips.

Many mothers, however, are not giving birth in settings that allow for simple doula work.  Today’s doulas, while certainly peaceful and warm, are savvy and stealth negotiators.   Doulas have a complex job of melding the miracle of birth with the reality of the medical model of care.

Advance Preparation

While a doula will help to provide information along the way, she is not a decision maker. A good doula prepares the couple far in advance, anticipating challenges.   Prenatal visits offer the opportunity to discuss the client’s clinical care situation and associated standards of practice. Preparation of a birth plan and approval by the OB or midwife and other colleagues is important.  If a provider shows resistance or is not comfortable with patients operating outside of standard procedure, it may be sensible to consider other available providers who take a more open and accepting stance on the birth process.

Potential Challenges

It is best to discuss common challenges and informed consent during the prenatal time. The doula can offer role playing scenarios based on simple, common interactions to help the couple become comfortable with positive self-advocacy that promotes a communal feeling between staff and parents.

While the doula is there to support the family and assist with the discussing options, the doula is not to speak for the parents. DONA, a national doula training organization, states in their training materials, “Clients and doulas must recognize that the advocacy role does not include the doula speaking instead of the client or making any decisions for the client.”

The Big Day

During  the birth, if everything seems to be progressing and the parents are showing good resolve, a doula’s job may be to simply offer up suggestions and allow the couple space.  The doula will keep her eyes open for changes.  If at some point, the doula thinks the mother may be need some guidance, she may say, “I think you may be better served in an upright position during contractions. Just consider it. Let me know if you need me to help you with this.” Then, in one contraction or 10, when ready, the mother can choose to makes the move on HER own will. OR her husband encourages her to make the move.  They run the birth, not the doula.  If at any point the couple seems to be struggling, then dependent upon prenatal conversations, the doula can assist more actively.

Challenges:

When medical intervention seems impending, it is best to avoid open conflict with staff and maintain a sense of well-being to facilitate labor for mother. Most of the time, a worthy doula can anticipate care to come and can alert her client to impending issues.

A doula might say, “You are doing such a great job. We may want to consider that based on your last check, your OB may not feel you are progressing quickly enough. They may start talking about augmentation soon.  Let’s take this opportunity to discuss, so you will feel prepared.  I remember, from our prenatal discussions, that you want to avoid augmenting labor, but it seems the situation is changing.”

When having discussion like above, using the following considerations can help to guide the discussion and keep things positive.

• Is there a need for emergent care?  Are the mother and baby currently safe?  Do we have time to discuss options or at least allow parents to direct the journey?
• Are there other ways to achieve the same outcome?  Rather than start Pit, try nipple stimulation or more upright labor positions.  Ask for a time frame.
• May the parents have a few minutes in private to discuss/integrate/process the situation?

To promote the spirit of choice, while in the presence of medical personnel, a doula can make the point to excuse herself from the room allowing the parents further privacy in decision making.

The birth is but a stepping stone.

Birth offers much opportunity for growth.  A doula is there to be the guideposts of birth, not to be the stop sign or a blinking red light. The best gift a doula can give is when after the birth, the parents say, “The doula was awesome, but we did it.”  The most empowering part of birth for families is the taking of responsibility on our own shoulders and feeling in control of their journey.  Birthing families is where doulas make a wonderful contribution.

Did your doula help you grow as a person?  What was your favorite thing she did to help you?

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