Tag Archives: doulas

Being a Doula #1

Through a convergence of circumstances, I was enlisted to sign up for a Doulas Of North America (DONA) training class last fall.  I completed the course even though the circumstances around why I was enlisted to certify as a doula changed.  Seeing as how I usually like to finish the things I start, I am going to go ahead and complete the certification, and thanks the confidence and trust of our SPB students, I will get to complete at least three births as a doula this year.

I would like to chronicle some of the things that I am learning along the way.  Although there are certainly enough organizations willing to certify that you have taken their course, and definitely lots of people who will help you promote the business for a fee, there is surprisingly little information out on the web on “how” to be a doula – what do you do once you complete your course and you are seeking work as a doula?

THIS page is a reminder for me to review before I go to a birth, and also shared as a resource for other people who are thinking about or new to doula work.  Some lessons are things I learned in class, others I learned via student experiences with doulas, and sadly, some I learned the hard way – by making the mistake, and learning from it.

Fortunately, I have a built-in source of potential clients from our childbirth classes to attend my certifying births.  Should I choose that this is the right path for me, I would also have a captive audience for my services. To be fair, I would ask them to interview at least two other people to make sure that I am the right fit for the birth they are preparing for.

Although I love birth and attending births, I cannot say right now that I feel an undeniable calling to this work.  My first birth as “the doula” was a wake-up call for me.

I went to my chiropractor for my regular adjustment, and as in previous births I have attended as labor support for students, I asked if there were any positions I could offer, or words that the mother needed to say out loud.  Imagine my surprise when his answer was that I was a hindrance to the birth…I was devastated.  I then called the student to break the news that I should not come back…it was so hard to do because their original doula had backed out on them (via text!), which is why I had offered to stand in for her.  Looking back now, I should have let them reflect on that information and ask them to be the final arbiters of the decision.  My leaving left them high and dry, because their other labor support decided not to go back either and they were left alone, whether they wanted to be or not.

On the other hand, I attended a birth earlier this week where I was able to fulfill my role as the doula.  The birth was amazing and both the mother and her coach did amazing.  Both the mother and the grandmother who served as the main coach said they couldn’t have done it without me.  While that is a nice compliment, it also leaves me feeling like I robbed them of the experience of “I couldn’t have done it without you” for each other…this is emotional stuff and I believe that bond should stay within the family.

To add to this, I am a planner.  I like to know who, what, when, where – having two students with impending labor, worried that they might be in labor at the same time, planning but not planning our lives…I still don’t know if that is the right path for me in the future.  I know that in this season it is definitely not something I will do outside of the work I want to do to complete my certification because we still have a nursling at home. My breasts were definitely a little uncomfortable after a long time of not nursing, and I was worried about my/her milk supply dropping.  In the future, once there are no more nurslings…I just don’t know.

I love birth – I love supporting – I *love* seeing a new soul welcomed earthside – their is no denying the miracle and the beauty – it is such an honor and a privilege to be there on Birth-Days.  There is still a lot I have to learn so that I can be the kind of doula I want to be – background support without being on center stage.

Thoughtful Thursday: DO use your BRAIN

As a mom, a childbirth educator, a consumer of health care and a doula, I am sad for THIS mom and her doula.  It reads like a story of a naive mom and an over-reaching doula; a hospital staff that missed warning signs in labor.  Thank God and the care providers who were on top of their game, the baby sounds like she is thriving today despite her rocky start.

How terrible to learn the hard way that a doula is NOT a medical professional. I am sad that her doula did more than facilitate her decisions by asking open-ended questions.  The doula influenced and made medical decisions.

There are many GOOD and GREAT doulas out there who understand their role as a support person ONLY.  Besides labor support, doulas are knowledgeable about pregnancy and birth based on their education, continued reading, and client experiences.

A good doula will share information (i.e., articles or good studies to read for both the pro and con of every option/consideration/intervention) and she will ask questions.  A good doula may share past experiences from previous clients, and she will NEVER decide for her client.

It is up to the client to use their BRAIN.  In short, what are the Benefits-Risks-Alternatives? What does my Intuition say? What will happen Next if I say yes, or what happens if I do Nothing?

It is up to each family to question more and trust less.  True informed consent means reading, educating, and asking questions, not just blindly following advice – be it medical or otherwise.  Even medical professionals can give you bad advice, and not because they are evil. They may be slow to catch up on evidence-based care while doing CYA to keep their insurance companies happy. Doctors have their biases, too, usually based on previous outcomes.  Their reasons are worth listening to – they are after all, professionals with years of education and experience.

What if their practices and/or malpractice insurance carriers are not caught up to evidence-based care as per American College of Obstetrics and Gynecology (ACOG)?  I encourage all pregnant mothers to read up on ACOG guidelines* so that you know what the current practice standards are.  If your care provider is not following the guidelines as set forth by their professional organization, ask them why.  And LISTEN to the answers so you can weigh the information against what your intuition and research is telling you.

It is the responsibility of every parent to weigh the benefits, risks, and alternatives to all the information they are receiving BEFORE they make a decision, whether it’s for their care or their children.

I will offer these words of caution: if someone on your care team is setting up an “us vs. them” mentality, it is a red flag to RUN the other way get more information. Pregnancy care is definitely a team effort. If someone says otherwise, whether it’s the doctor, midwife and/or the support team – some part of the story is is missing. Find out what their history is if you can, decide if it’s something you can work around, and if not, build a new team.

My little equation:
Childbirth Education + Supportive Care Providers + True Informed Consent = Empowered Birth

Making true informed consent decisions are part of the equation in empowered birth.  In addition, choose your care providers wisely – both the medical and support team should be willing to work with you for a Healthy Mom, Healthy Baby outcome.  Another part is to set yourself up for success: eat well, exercise, meditate (relaxation practice), avoid harmful substances, educate yourself on the process (Bradley Method® classes cover all these topics). Having a good foundation for what is normal, the variations, and true complications of pregnancy and childbirth will help inform you as you make decisions about your care.

Will every birth play out just as you imagined?  NO WAY.  However, by following the above equation, I believe that every family CAN have a birth experience that they are proud of: they know that they did all they could to have the birth they planned for, they recognized the forks in the road, they made carefully considered decisions as a team, and proceeded with the informed choices that yield a Healthy Mom AND Healthy Baby.

What are your thoughts on doulas, doctors and informed consent?

Want more info in evidence-based care? Read my feature article in the ICAN Clarion, a quarterly newsletter HERE,  Usually only available on a subscription basis, this issue was made public in honor of Cesarean Awareness Month.

*ACOG publications – three to start with
Term is redefined as 37-42 weeks
Reducing the primary cesarean rate
VBAC guidelines