By Debra Flashenberg
Lately, I’ve been struggling with some of the stories I hear regarding appropriate vs. inappropriate behavior from labor support doulas. While I am not currently taking on any births, I was an active doula for almost ten years and have tremendous respect and admiration for how a trained labor support doula can support a laboring woman. Unfortunately, some doulas are using poor judgement and creating negative discourse with care providers. This negativity can tarnish the value a doula, and reflects poorly on doula work as a whole.
For those who are just learning about the doula world, let me take a moment to explain the role of a labor support doula. A labor support doula is a trained professional specializing in childbirth who provides continuous physical, emotional and informational support to a laboring woman. The doula is involved prior to birth as someone who can help the mother choose and visualize her birth preferences and plan, and after the birth to help ease her transition into motherhood.
Here’s a simple rundown of the “Do’s and Don’ts” of the doula. Hopefully this can help clarify the role of the birth doula, and can assist you in your interview process (which is essential!) if you are considering hiring a doula:
The doula should be able to provide evidence based information when the mother has to make a decision and not make the decision for her: The doula should be able to “read” the situation and have many different tactics to offer the mother for pain relief. The doula should also know when to be quiet and when to speak up. One of my favorite aspects of being a doula is learning how I could best serve the mother during her labor. Most people do not know how they will react to, and what kind of care they will want, until in labor. I have had some moms completely positive they would want massage through the whole labor only to realize they just needed someone to be present and talk them through the contractions. During my last labor, I was more or less content hanging out on all fours with my birth ball. My labor was progressing, but my doula saw that we needed to shift the energy and try a different approach. I was rather reluctant to take her suggestion of moving to the shower, but I am so thankful she urged me to do so! Not only was I much more comfortable, I really turned a corner and my labor swung into high gear soon thereafter!
Help the partner be as involved as he/she would like and offer guidance: Even for experienced parents, labor shifts the typical role partners take on in their relationship. For some, it is very challenging to watch a loved one navigate how to move through labor and be compromised from their usual capacities. A doula should be able to guide the partner as to how to best support the laboring mother. The doula may teach the partner how to massage the mother’s back or invite the partner to tell the mama a comforting, loving story the two of them share. The doula can also help guide the couple into a close, intimate space so the mother can feel relaxed.
Help the mother create her birth plan or birth preferences: Once the doula is hired, a prenatal meeting is scheduled to learn of the mother’s vision and preferences for her birth. At this time, the doula can be extremely instrumental in discussing the pros and cons of routine interventions. During the meeting, the doula will be taking notes so she can be familiar with the birth preferences, and help remind the mother of her wishes should the birth start to take shape differently than planned.
Help navigate the “system:” It is helpful for the doula to be familiar with hospital at which the mother is birthing, or at least with the general way hospitals function. For example, a doula should understand the basic protocols that take place upon arrival at the hospital. It is rare that a woman gets directly admitted without going through triage first. A doula should know that you can request a different nurse to attend to you if there is friction, and understand that it is your right to request not to have students in the room if you want more privacy.
Every doula should have a back up doula: Emergencies and illness are never planned so it is vital for your doula to have a back-up. In the 100 or so births I attended, I only had to call my back up to help me once. Two mothers (whose due dates where ten days apart) were in labor at the same time. The back up doula may not have met the mom ahead of time, but she should have the notes the original doula took during the prenatal meeting.
New doulas should have a mentor (in my opinion!): I will start by saying this is purely my opinion, but I believe that new doulas should have a mentor. When I first started out as a doula, I was fortunate to have the support and guidance of my mentor, Terry. It was reassuring to know I had someone to call should I be facing a situation that was unfamiliar to me. I did call Terry at the first birth that was presenting as back labor, and she gave me some very useful tools to help the mother cope. I also used to call Terry after births to discuss the events and to process what I learned from the experience. In recent years, I have had the honor and pleasure of mentoring new doulas as they start on their own journey.
Doulas are not medically trained: Doulas should not be giving medical advice or performing medical tasks such as taking blood pressure, using a dopler to assess fetal heart rate, or internal exams. However, a seasoned doula is often capable of “guestimating” how dilated a laboring mother is by the emotional and physical signposts that are demonstrated. Admittedly, I do carry a thermometer in my doula bag (although, I will not personally take the mother’s temperature) for the instances of the membranes rupturing and the care provider says we can stay at home to labor as long as there is not any sign of infection (I was surprised to learn how many people do not have thermometers at home as I dashed to CVS at 2am). In terms of medical advice, a doula can offer the evidence based information but should not stand in the way of the medical staff. This can create negative discourse with the care provider.
The doula should not forget to discuss how to respond to emergencies: Most doulas will face a precipitous birth, or unplanned home birth at some point in their career (I had mine with a third time mom who’s water broke and immediately she was pushing). It had not occurred to me to have this discussion with clients until I heard how poorly a precipitous birth was handled. My student explained that she was handling her contractions very well, and kept putting off heading to the hospital. When she realized she was too far along to head out, the doula, instead of calling 911 to have EMT come to take over the situation, started calling home birth midwives that she knew hoping to get one to come to the woman’s apartment to deliver the baby. My jaw hung open when I heard this. None of the midwives she called came, so the woman ended up with an unassisted homebirth with an EMT arriving after the baby was born.
The doula should support and try to facilitate the birth the expectant mother wants, not the one the doula wants: Within the circle of doulas I know, the majority of them strongly believe in natural childbirth. Many have had or attempted home births, or chose a birth center in order to for go a hospital birth. Regardless of the doulas own personal birth experience and beliefs, it is not her place to put her own views in front of the client’s desires. I have recently encountered a woman seeking a doula who felt she couldn’t find anyone who would support her in labor because part of her birth plan included getting an epidural. From the few conversations she had with doulas, she was under the impressions doulas were only used for those intending to have a natural birth.
The doula should not ask the mother to lie to her care provider: This story again comes from one of my students. She explained that her doula told her to lie to her care provider about when her water broke so she could stay at home longer. When the doctor told the laboring mom to start to head into the hospital, the doula instructed the mom to say they were on their way, with the intention of staying home a few more hours. This goes back to my point, doulas are not medically trained and should not be interfering with the direct care the doctor is trying to give.
A doula should always have a reachable 24/7 phone number she will answer: Part of the doula job—and I must admit was my least favorite part of the job– was to be available to the client 27/7 three weeks prior to her due date and up until she gave birth. Theoretically that could be five weeks on call for one client. Of course, most doulas have multiple clients so they are always on call. If there is a period of time the doula is unavailable, the back up doula should be ready to step in. One of my friends told me that her doula missed her birth because she never answered her phone or texts.
As I am writing all this, I am hoping I am not coming across as anti-doula. I absolutely love and support the doula profession! I think the skills and support they offer is invaluable. Instead, my intention is to to help those seeking to work with a labor support doula by providing information to skillfully interview and find the best fit!
Debra Flashenberg is the founder of the Prenatal Yoga Center. She is a certified doula, Lamaze coach, midwife, and certified vinyasa yoga instructor. She is continuously in awe of the beauty and brilliance of birth and is the proud mother of baby boy Shay.