What is a doula and do I need one?

doula LouiseEver wondered what a doula really does? Ever thought if hiring one for your pregnancy and birth would be beneficial? Louise tells us all about what her role involves and how she makes it work into her family life!

I’m Louise, and I’m a Birth Doula.   I’m also an NCT Practitioner and I facilitate my local Positive Birth Movement group.

“What does a birth doula DO exactly? And, why should I hire one?”  I hear you cry!

A doula recognises birth as a key life experience and has undergone training to understand the physiology of birth and the emotional needs of women and their partners during this time.

She offers continuous, emotional and practical support to women, their partners and their families during pregnancy, birth and early parenthood and also provides an objective viewpoint and information to aid decision making.

Studies indicate that a natural by-product of this type of support is better outcomes for babies and their mothers: shorter, more comfortable labours, fewer interventions and greater maternal satisfaction. A doula does: support your choices, provide continuity of care, offer evidence-based research and information.

A doula doesn’t: push any particular birth method, make decisions for you or exclude your birth partner.

So, if it matters to you if you know the person who looks after you in labour, and if you want to have the support of someone knowledgeable who you know and trust, this might be an option for you.

There’s no such thing as a ‘typical woman’ or ‘typical baby’ or ‘typical labour & birth’ so I can’t really describe a ‘typical doula gig’ but I can give you an idea of what I do based on my experiences so far. Clients get in touch with me, and, if I’m available around their estimated due date (and it IS an estimated date parents! More about that later), then we arrange to meet up.  This initial meeting is free and there’s no obligation on either side.  Usually parents meet with 3 or 4 doulas before deciding on ‘The One’ – it’s really important that both parents meet me and that we all ‘click’.

Once I’ve agreed to be someone’s doula, I block out about 5 weeks in my diary when I will be available to them, exclusively, up until they have their baby.

I go on-call for parents 10 days before the estimated due date and I don’t book anyone else in until 3 and a bit weeks after that date.  This is because all of my babies came at 43 weeks so I like to allow for that plus a couple of days off-call before I go on-call for my next client.  That’s just me, very much shaped by my own experiences!  Most doulas’ on-call period is 2 weeks before the estimated due date until 2 weeks after.

Before that time though, I meet up with parents at least twice for antenatal sessions that usually last a couple of hours each.  These take place about a month before my on-call period begins.

Parents set the agenda and usual topics are:

  • De-briefing any previous births
  • Understanding the physiology of birth
  • The role of hormones and the effect of the birth environment on them
  • What will help the birth process, and what won’t
  • Physical skills for labour and birth – positions, breathing, relaxation & visualisation techniques.
  • Working through any concerns and understanding your aspirations for your birth
  • My role, partners role, how we’ll work together as a team
  • Transition to parenthood

I’ll often meet up with a mum just for a chats too in the months beforehand – she might come on a dog walk with me, or pop in for a cup of tea if she’s nearby or I’ll call on her.  This happens especially if I’ve been booked quite early on in her pregnancy, so that we really know each other well by the time we do the antenatal sessions.

I facilitate the Tunbridge Wells Positive Birth Group from my home, and usually doula clients come along to that once a month too.

It’s really, really common for mums hiring me to call me a lot to talk through things as they reach about 35 weeks – it seems to me to be a time when women naturally start wanting to sort through any anxieties they have that they may have been pushing to one side up until that point.  These seem to rise to the fore at a time which is, thankfully, a good while before labour is imminent, and that’s great: it means they have time to talk things through, reflect on our discussions, talk them through again, reflect a bit more, talk a bit more and hopefully that process means they’re in a good place mentally and able to relax and feel confident before their labour begins.  It also means that we continue to build our relationship and trust with each other.

When I first go on-call, I’m pretty relaxed. Yes, I have my bag packed ready, my phone fully charged & on ‘loud’ 24/7, my family know I could get called at a moment’s notice, I don’t drink any alcohol, but it’s not until around the 41 week stage that I start putting serious effort into going to bed early (I like to be asleep by 10pm, in case I get called at 3 am) and being militarily organised: every evening I run through the next day with my husband – where he’s going to be, how quickly he can get home, whether or not he’d be able to do the school pick-up with less than an hour’s notice (my youngest is 9) etc.  Any gaps have to be filled, usually by one of my teenagers, who aren’t always great at answering their phones – which does introduce an element of anxiety, or by one of my many school-mum friends.

It’s very usual for mums to call me after their 40 week check up with their midwife, as it seems to be at around this point that induction gets mentioned.  What mums usually say is “I went for my check-up and the midwife said that next week she’ll book me in for an induction at 42 weeks.”  I find it’s usually best to talk this through face to face with both parents: it’s vital that they understand that the induction is being offered and that they can decline it and take up the other options that should also be put forward.  They need to understand the procedure and the possible risks and benefits of induction, in order to make their own, informed decision on what’s right for them and to know that I’ll be there to support that decision 100%

Now, back to that Estimated Due Date (EDD) – we usually talk through the fact that it is exactly that: Estimated!  Term is anything from 38-42 weeks for a single baby.  So their baby is quite likely to want to make an appearance at some point during that 4 week period. Some babies, like mine (43, yes, 43 weeks! I was Climbing. The. Walls!), take a bit longer than that. I completely understand that it’s really hard not to get fixated on the EDD (I’ve been that person), especially as it’s likely that most of your friends and family will do too and may start ‘phoning/texting on a daily basis with queries like “anything happening?” and, without meaning to, they’re creating an added pressure to ‘get on with it’. Taking a leaf out of Kate & William’s book and just providing your nearest and dearest with a ‘due month’ might be an idea.

Induction, and other options suggested during pregnancy, labour and birth can be construed by parents as something they have to accept.  It’s not always clear if this is because of the way they have been presented by healthcare providers, or down to the way parents have interpreted what’s said to them – I suspect it’s a mixture of both.  Either way, it’s important to clear that up and for them to be aware of all options, and that’s part of my role too.

So, when a woman waits until she goes into spontaneous labour, she’ll usually give me a ring when she feels that ‘something’s happening’ – this gives me the heads-up to get all my personal arrangements sorted.  Often it’s late afternoon or evening time when I get that call – I don’t need to do anything at that point.  If women wake in the night feeling that things are starting, they tend to wait until the morning before calling to let me know, as long as they’re happy and unconcerned.

More often than not though, I’ll get a call in the evening and then THE Call some time in the night.  THE Call is the one where parents are asking me to come over.  At this point, mums are finding their contractions are taking up all their attention, getting stronger, longer and closer together and she may be feeling like she’s ready for some extra support.  Or, it may be that her partner feels that he/she is needing some support.  Either way, if I’m needed I go. (A doula will usually come to your home before you call the midwife for a home birth or before you set off to the Birth Centre or Hospital if that’s where you’re having your baby).

I’ll have had a shower before bed and have my clothes laid out (comfortable & layers) so that if I’m called in the night I just have to brush my teeth, get dressed, grab my bag and go.

Once I arrive with a mum or couple I’m usually with them until their baby’s born.  Sometimes though, I’ll go back home if we all decide it’s still a bit too early in labour.  I’m always happy to go backwards and forwards if that’s what’s needed, because I’m aware that there can be, for a labouring woman, an element of ‘needing to perform’ (for want of a better phrase) once I’m there!  Or, I might go into another room and read my book, watch TV or sleep so that mum doesn’t feel observed in any way, but knows I’m right there if she needs me.

Usually though, I’ve been called because mum really needs some extra support.  She needs reassurance that everything is ok. She needs reminding that her contractions are a muscle working really, really hard, over and over again and that they are a sign that her body is doing exactly what it needs to to birth her baby. She needs to feel safe. She may need encouragement.  She’ll probably appreciated the distraction of someone new arriving.  She might need help getting into a comfortable position – perhaps making a nest of pillows, quilts etc. She’ll need to be reminded to drink and try to eat a little and to go to the loo.  She might need a hug.  She might need to relax in a bath that’s kept at a comfortable temperature. She might find a wonderful lower back massage soothing. These are all particular ways I can support her.

I’m always very, very focussed on partners and their needs too.  Dads, for example, can feel quite anxious at this point. They visibly relax when I arrive and usually prefer me to stay once I’m there, even if I’m in another room.  Their supporting role is vital: they’re the person that Mum is closest to and trusts the most.  It’s my job to support them so that they can support her.  They need to feel safe, reassured and confident.

If parents are planning to have their baby at a Birth Centre or Hospital I provide the support so that they feel able to stay at home for as long as possible.  However, I always listen to the woman in labour – if she feels she wants to get going, that’s what we’ll do. When it’s time to leave I travel with them.

Wherever they are having their baby, there will be a midwife joining our little team at some point.  I consider it my responsibility to make sure that this union goes well.  Most midwives seem happy with the presence of a doula, but not all.  What I say to parents antenatally is that, if mum and dad are ok, I’ll spend half and hour ingratiating myself with the midwife.  By this I mean being friendly, considerate and respectful – chatting, helping, making sure I’m not in her way, listening etc. so that she feels comfortable with me there and hopefully realises that I’m not going to be a trouble-making-pain-in-the-butt.  Remember the last time you were in company where there was ‘a bit of an atmosphere’ between two people and how uncomfortable that feels?  So, you can see why I feel this is always time well spent.  It also means that we work together in a collaborative way in supporting my clients – we’re all part of the same team.

During the established first stage of labour, wherever she is, Mum might need much the same support provided during the latent phase earlier.

Her contractions will be closer together, stronger and longer.  Having got the room to her liking – usually dimmed lights, quiet, privacy & peace ensured – I watch out for signs of tension in her body: shoulders rising, jaw clenching, furrowed brow, clenched fists, scrunched-up toes etc.  I’ll quietly remind her to relax, maybe placing a hand gently on each shoulder.  What I’ve noticed is, the more time I’ve spent with a woman antenatally, the more she responds to my voice during labour and women often say afterwards things like “I just heard your voice and knew everything was alright” or “the sound of your voice made me feel relaxed”.  Trust me, this isn’t because I have a particularly mellow, honeyed voice or I’m doing anything clever: it’s because she knows me and she trusts me.  So, when I suggest that she relaxes or that she changes position or that she’s doing really, really well or I assure her that everything is fine etc. she can accept what I’m saying, she doesn’t have to consider it too greatly.  We know that women need to be able to switch-off the decision making part of their brain in labour.

Some women need to comforted with every contraction, some women need to be massaged for ages, some women need nothing other than to know that her partner and I are there.  Every woman is different, every labour is different.

She also knows that me and her partner are there for the duration.  There’ll be no change of shift for us, whatever happens, whoever comes and goes we will be constant.

Again, I’m keeping an eye on her partner all the time.  Making sure that he or she is relaxed and confident. A labouring woman may look and sound completely different to any way that her partner has ever seen or heard before and sometimes they need reassurance that certain behaviours are normal.  If partners are getting tired, I’ll suggest they lie down and have a sleep, or go and get some fresh air and something to eat if they are both happy with that.  Dads are often very chivalrous and offer for me to have a nap during a longer labour.  Usually I decline – after all, once their baby’s born, I get to go home and sleep for as long as I want – I won’t have a new baby to look after!

Sometimes labours progress steadily and sometimes they don’t.  Sometimes there’s a need for discussion and decision making.  My role then is to answer any questions parents may have and to make sure they get the information they need from caregivers and that they understand it, once again, in order to make sure that they can make any decisions in an informed way.  I then support any decision they make 100%.

After their baby is born, if everyone is ok, the midwife and I will leave the new family alone for a while to have that magical time together.  I go and sit outside, jot down my notes (I keep a birth record for every birth I attend), have something to eat  or if we’re at home, I’ll tidy-up, make tea and toast for everyone etc. and I’ll pop back after about 40 minutes.

Usually I leave about 2 hours after the baby is born – once everyone is settled and happy. I then visit at a time that suits the parents to support them in anyway needed and to talk through the birth.

I don’t do postnatal doulaing, but by the time I’ve been at someone’s birth, I have a relationship with and a vested interest in that family and will always pop ‘round, at the drop of a hat, without any charge, if they’re experiencing difficulties. I am available for them to get in touch with any queries or worries pretty much forever more after that.

One thought on “What is a doula and do I need one?

  1. That was a great piece of reading Louise, from the heart, and exactly as I imagined you would be. It will be a great help for parents who are not sure what a Doula does to make an informed decision, and I would imagine to jump at the chance!

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