Tell Me About Doulas

[z2akids]

I didn't want to continue to hijack another thread, but I am really curious what those who are doulas, have had doulas or who work in L&D think is the role and purpose of a doula.

Let me preface this by saying, I'd never even heard of a doula 12 years ago when I was pg with my first. I would not have wanted anyone other than my DH in the room with us while we were having our kids. We didn't have friends or grandparents or anyone like that there. I cannot imagine having hired someone to be there in tha very intimate time with us.

That being said, when I think doula - I think basically paying someone to fill in a role as friend/family member. Someone to apply counterpressure or to supply support while you are on a birthing ball. Someone to take some pictures so that your spouse can be in them as well.

But, when I read threads here, I read things like - deal with the nurses, tell the nurses what mom wants, tell the mom the pros/cons of contemplated treatments, etc. Is this the role that doula is fulfilling generally?

For L&D people - if a doula came out and told you mom wanted x treatment done or stopped, would you? I see this from my hospital view and cannot imagine altering treatment of an A&O competent adult based on what a "friend" told me. If a friend/family member/paid support person came to the nurses' station and told me that the patient wanted X, I would head to the room and talk to the patient, but I would do the same thing if the patient hit the call button. Unless the individual is the POA, I take treatment decisions from my patients, not other individuals. Granted, my patients are sick, so perhaps there is a big difference there. I cannot tell you how many times I've been admitting an 80+ year old COPD patient and asked them about a flu shot and their 50/60 year old child tells them - oh, you don't want that, everyone I know gets the flu after the shot. They wind up throwing up for weeks. I just keep my mouth shut and move on and discuss with with the patient when visiting hours are over.

Do doulas take courses on reading strips and are they competent to read the monitors and what is going on with baby? Do you become certified/licensed for that sort of thing? As a doula, do you advise your client on what a decel (for example) means in terms of what the nurse/doctor wants to do?

Honestly, I think it I had wanted a paid person in the room with me while laboring, it would have been someone with a massage license. Perhaps I am just too much of a control freak to give up my voice to advocate for myself to someone else.

[steph410]

I had a doula for 2 of my births- both were planned natural births. Neither one of them interfered at all with the nurses or doctors. They were there to support me through the pain of labor and to be encouraging. The first time I sought out a doula was because of the previous birth that i had that was very scary for me- it was a quick labor that was painful and I was not prepared in any real way to deal with the pain of the contractions. I wanted someone besides my husband to be there for me. The doula that I hired helped a lot in the initial stages of labor to help me relax, which IMO made labor go faster. And after the birth she stayed with me when my hubby had to stay with the baby and we were in separate places.

Anyways, I think doulas are amazing and very necessary for some people who are dedicated to having a natural birth. Labor is hard work and having support is key. I don't feel either doula I had told the medical staff what to do or even advised them. They were super professional.

[JennTheMomma]

I'm a doula and I do not ever tell anyone what to do. Many hospitals encourage the use of doulas here and even employ them. I have more to say but I'm mobile.

[melilo]

Doulas are women who support another woman in labor, either alone or in tandem with the mother's birth parter (father, mother, whomever). We are trained to offer phsycial and emotional support, nothing medical. We can provide education to mothers that desire, but we do not give advice.

Doulas are not supposed to speak to any staff on behalf of the mother. This is not proper. A doula's job is to help the mother find out her desires and to use her own voice to have the birth she wants.

For more info, check out DONA International

I also have a more thorough description on my website Rubber City Doula

[Belle]

My doula never interacted with the hospital staff and had a strict policy against doing so. Most doulas I know have this same policy. She was there solely for me and my husband.

The difference between having her and just another family member or friend was her training in childbirth. When I was stuck at 8cm (in transition!) with my first kiddo, she was able to suggest position changes, massage techniques and provide specific encouragement through each contraction. She was able to help my husband help me when he felt at a loss.

The nurses at the hospital were great, but they were mostly familiar with epidural patients who couldn't and didn't move on their own. So they seemed to be at a loss for what to suggest to me to help relieve some of my pain and hopefully help me finish dilating and get to pushing.

Do doulas take courses on reading strips and are they competent to read the monitors and what is going on with baby? Do you become certified/licensed for that sort of thing? As a doula, do you advise your client on what a decel (for example) means in terms of what the nurse/doctor wants to do?

No, no, and no.

The closest she would have come to interacting with staff is to get really close to my ear/face to tell me what they were doing or what they were asking me, because they had a tendency to just talk to me loudly from the end of the bed or from the computer, not realizing that my "sphere of communication" really narrows the further I get into labor.

Honestly, I think it I had wanted a paid person in the room with me while laboring, it would have been someone with a massage license. Perhaps I am just too much of a control freak to give up my voice to advocate for myself to someone else.

Some doulas do have massage training and/or licenses. A lot of them go to workshops for different things to help women in labor, massage being a big part of that. As for giving up your voice, that's not the role of a doula at all. She does not, or should not, speak for a laboring woman. To be honest, though, the further I get into labor, the more my husband does have to speak for me because I just lose all sense of caring about anything except getting through the next contraction and getting baby out. So, for me to be able to think through and make clear-headed decisions at the later stages of labor is somewhat difficult unless the person who is talking to me explains things very calmly, clearly, and close to me, and asks very specific questions. I'm not out of my head, but my head is definitely working on other things!

[steph410]

just wanted to add too that a doula is quite different than a friend or close relative because they have studied extensively about birth, the stages involved in labor, and what to expect. A close friend might be well-meaning, but also might have very little knowledge about birth and what happens/is likely to happen at any given point.

[EmilytheStrange]

My doula contract clearly states that she is not the hospital staff mediator. But, if the hospital staff start telling me that I need to get an epidural or I'm not progressing fast enough or other things that I might not understand - the doula can explain to me their feelings so that I'm not pressured into making a decision out of fear, but with knowledge.

The reason I am getting a doula this time is because I had very rough back labor last time. I know that the reason it took me so long to progress was because I wasn't relaxing during contractions. I knew it at the time and I couldn't make myself relax. My husband was great, but he's not experienced and knowledgeable about how to help me relax. He had great suggestions, he tried all sorts of things - but that's not his career.

He will be there this time, he will walk with me, he will be the one applying counter pressure, he will be the one holding my hand, looking into my eyes.... but, he will not have to stress about where I am in labor, am I relaxing, what can we do, etc.

My doula will be the one who guides him and uses her know-how to help me get through the labor unmedicated.

and she will be there to help me if we struggle again with breastfeeding.. yet another thing that I need an experienced woman to assist with.

My sister has said she'd love to be my doula if she lived closer. I smile and nod, because I think she'd be great to have with me in the room, but she has never had back labor with her 4 babies. and in order for me to relax about what will likely be another back labor, I want a doula who specializes in methods of helping the baby turn, etc.

HTH

[Palooka]

Originally Posted by z2akids That being said, when I think doula - I think basically paying someone to fill in a role as friend/family member. Someone to apply counterpressure or to supply support while you are on a birthing ball. Someone to take some pictures so that your spouse can be in them as well. But, when I read threads here, I read things like - deal with the nurses, tell the nurses what mom wants, tell the mom the pros/cons of contemplated treatments, etc. Is this the role that doula is fulfilling generally?

For me, yes. I had 2 "doulas." The first was a good friend and family member who had a natural birth 3 years earlier, and the second was a volunteer doula-in-training who I had never met before going into labor.

My friend brought her knowledge of me and what I wanted. When I was puking and the midwife was about to give me a dose of regelin (anti-emetic that makes me super tired) my friend spoke up because I was too busy puking. She asked the midwife if they could do an IV dose of zofran instead. They could, and the midwife even commented on what a great suggestion that was because they all knew I wanted to be awake and alert. My hubby wouldn't have known the difference between the two drugs. She and hubby also took turns squeezing my hips, which was a huge help!

The volunteer brought some calming and comforting techniques she'd learned and practiced before. When things got scary she had some really mellow mantras she'd repeat to bring me down.

They both were very helpful to me in different ways, though later I heard that they felt a little awkward having to work together. So next time I will have just one. Thankfully, my friend so enjoyed helping me that she has decided to become a certified doula!

Originally Posted by z2akids Do doulas take courses on reading strips and are they competent to read the monitors and what is going on with baby? Do you become certified/licensed for that sort of thing? As a doula, do you advise your client on what a decel (for example) means in terms of what the nurse/doctor wants to do?

A doula would/should never argue with a nurse or midwife, though they might ask about alternatives as in the zofran example I gave above. Doulas are there to support the mother, not to contradict the medical experts. Doulas are not trained to read strips or anything like that. They are trained to read moms. It's like having a good friend who has also seen 50+ babies be born--which is how many I think my friend needs to see in order to get her certification. It's not a license, because anyone can say they are a doula and the state can't prosecute them (the way they could if someone said they are a doctor but they weren't licensed). However, there are boards that certify doulas, and they have many requirements. My friend will probably work part-time (she has 3 little ones) on getting her certification for the next couple years.

Originally Posted by z2akids Honestly, I think if I had wanted a paid person in the room with me while laboring, it would have been someone with a massage license. Perhaps I am just too much of a control freak to give up my voice to advocate for myself to someone else.

It's not giving up your voice, it's adding to it. A doula shouldn't ever speak for you, she should ask you what you want and then help you express it. Husbands can sometimes get nervous or scared because they are so emotionally invested in you and the baby. A doula is there as a calm person who cares but won't lose her cool easily. They also do things you might not realize you need, like bring you a good smelling tea or run and find a birthing ball when you're too in pain to think.

[z2akids]

I appreciate the comments so far. They are more along the lines of what I though a doula's purpose was. But, it also seems that they are a ways from what many posts tend to imply.

[JennTheMomma]

I think everyone did a great job explaining what a doula does. All doulas are different and have different backgrounds and experiences. I have went to college for medicine, but after becoming pregnant with ds1 decided not to pursue a career in that. After his birth I decided to work in the birth community. I have many certifications in childbirth and beyond. Not all doulas go the extent I have, but I personally love learning and am very passionate about my career so I want to learn everything (like the jack of all trades type thing).

What I offer my clients is physical and emotional support, along with evidence based education. Everyone is different and needs something different in birth. Some clients need me for distraction, others need me to help them focus, some need me to be able to massage them while they lay in their husband's lap, some don't have a partner with them or any family around, some are afraid of birth or the hospital and need me to help keep them calm/relaxed/comfortable. And yes, some need me to be their voice. I spend a lot of time with my clients building a relationship and foundation with them during their pregnancy, the nurses usually meet them for the first time in labor. I've never gotten in the way of the nurse/Doctor. That is not my place. My place is for the woman and her partner. I am not a doula just for women seeking an unmedicated hospital birth. But for women who have a homebirth, epidural birth and I've even been with a woman having a c-section (she had no one else to support her and just wanted someone there that she knew and trusted).

Once birth is over with I am also certified in breastfeeding counseling and education (currently working towards the boards exam). I help the mother establish breastfeeding. I stay with her for a few hours after birth, longer/shorter if she wants me to. Many of the hospitals I have doula'd at do not have a Lactation Consultant or only 1 who doesn't get to spend enough time with mom after birth (and may not even come in until the next day depending on when birth takes place). I also do postpartum home visits to mom, helping with breastfeeding, going over her birth, bringing food, answering questions, and so on. Whatever she needs, that's what I'm there for.

I am lucky to live in an area that welcomes doulas. The closest hospital to me loves doulas and encourages every woman to have one. The other closest hospital employs doulas, but also welcomes indpenedent doulas like myself. Doulas there also run the childbirth education program. Doulas are not a new invention, they have been around for a long time. My own mom had a doula with her babies (except for me because I came too fast, even before the Doctor).