I’m a birth doula. When I tell someone I’m a doula, I invariably hear one of the following:
“What’s that?”
“Is that like a midwife?”
“Oh! You mean a birth coach?”
It has occurred to me that I am currently in a profession that people generally know little about. Occasionally, I even meet a pregnant woman who has hired a doula, but because she does not fully understand what a doula does, she does not know how to “use” her doula (I’m not joking!). Therefore, I have decided to write a user manual for your birth doula, so that you can get the most out of having her around, once you have decided to purchase her services. Luckily, there is no technical jargon in this manual, so all you technologically impaired people can relax (or ask your doula to help you relax!). This manual is for you if you have ever wondered what the “informational, emotional and physical support” aspects of a doula’s job description entails.
STEP 1: Hire A Doula
This can be the most confusing step. If you have never had to hire anyone before, it can be intimidating; however, it is good practice, as you will mostly likely need to hire a babysitter at some point in your parenting career. You can start by collecting any business cards which may have been left by local doulas at your midwife’s or doctor’s office. Or you could skip right to the internet. Contact several doulas via email or phone to confirm that they service your area and that they are available during the time surrounding your due date. If you live in an area with a low concentration of doulas, you may not have the option of choice. Assuming you do, narrow your options down to a few which stand out to you and set up appointments to meet for consultations with them. A “consultation” is an opportunity for you to meet each other, get to know one another, as well as for you to interview her and decide if she is the right doula for you. Ask about her education, experience and certification. Doulas are not a regulated profession, so one does not need to have completed a certification course to call themselves a doula. Furthermore, just because a doula is not certified, it does not necessarily mean she is inexperienced and just because a doula is inexperienced, it does not mean she would make a lousy support person for you. See why this is confusing? Decide on your priorities as a doula client. Perhaps it is very important to you that your doula is research savvy because you expect a lot of informational support from her? Perhaps it is more important to you that the doula is amiable, or motherly, because you need a lot of re-assurance? Maybe you want a doula who gives a good massage? Perhaps you seek someone with experience with VBAC, breastfeeding, post-partum care, LGBTQIA families, twin pregnancy, crisis pregnancy, birth trauma, or any other unique family / cultural situations you are in? What each client wants and needs is going to be unique to them. Pick the doula who you think will best help you to achieve your birthing goals, someone who listens well to what you want, as well as someone who you like and feel comfortable with. Then explain what you expect of your doula to your chosen doula so she can determine whether she can help you achieve the type of birth experience you envision for yourself.
STEP 2: Sign A Contract
This is not always necessary, as it is up to each individual doula whether she operates with a contract or not. I like the idea because it provides an opportunity to discuss the expectations of both the client and the doula. It also removes any awkwardness, confusion or surprise over issues of payment.
STEP 3: Pay For Your Doula
Yes, you do need to pay for your doula. Unless you are fortunate enough to be benefitting from a doula-in-training who is willing to exchange her services for the opportunity to use your birth to achieve her own certification goals, or unfortunate enough to be eligible for pro-bono work, please pay your doula. Please note that not all doulas-in-training are willing to work for free or cheap. Also many experienced doulas are willing to work on a sliding scale to ensure low-income families have access to their services. There are a number of reasons you ought to be willing to pay well for her services if you can afford them. If you would like to know why it is important to pay your doula for her services, please read more about that here.
STEP 4: Set Up Prenatal Appointments With Your Doula
Plan to meet with your doula before your labour starts. It is very important to build a relationship with your doula, ask any questions you may have as well as discuss your birth plans and goals. Your doula can only help you achieve your dream birth if she knows what your goals and priorities are. Also, your doula will be more of an asset to you as a support person during your labour if you feel comfortable with her and trust her.
STEP 5: Keep In Touch With Your Doula Prenatally
Understandably, clients tend to skip this step. I think this is where such clients are potentially missing out the most. Talking with your doula prenatally about the decisions you are making for your care or the feelings you are having allows you to benefit from her experience and knowledge. Clients may not keep in touch with their doulas between prenatal appointments because they have busy lives, they have so many other appointments with their care providers, they expect their health care provider to provide them with all the informational / emotional support they need during pregnancy, they are very private people, they feel like they are “bothering” their doula with silly questions, or they feel like the scheduled prenatal appointments are all that’s necessary to build a relationship with their doula. Some of these reasons are preferences for what they want the relationship to be and some are misconceptions. Each client ought to be able to determine their relationship with their doula, I would not argue otherwise. My goal is to break down some misconceptions about your doula’s role. Your doula is typically more available to you than your health care provider. She is not too busy for you and she cares about your emotions. She should not feel “bothered” by your “silly” questions. No questions are silly, they are the means by which you can gather the information you need. You hired your doula to provide you with information, so ask her your questions! Her answers will probably be more accurate than your Aunt Martha’s or your best friend’s. Most doulas love reading and learning about birth-related topics and enjoy sharing the information they have acquired. Even if she does not know the answer to your question, she would probably love the challenge of finding out the answer for you or directing you to the appropriate person to address your questions / concerns. Furthermore, if you are having a difficult time emotionally during pregnancy, you can feel free to draw on your doula’s support. Your doula should care if you are having relationship issues, you got a concerning prenatal test result, if you have any specific fears about the upcoming birth, or if you are struggling with mood swings. By talking with these issues with your doula, you can build a trusting relationship with her, acquire the information you need and get directed to any additional resources you may benefit from. Doulas do not replace family members or partners. It’s important to keep in touch and talk with them too, but your doula will certainly be in the birth room with you during labour, whereas your friends and family members may or may not. For example, if Aunt Martha knows how terrified you are of vaginal tearing, but your doula does not, your doula cannot provide you with information which may re-assure you, give you the means to make a birth plan which reduces your risk of tearing and help you implement your birth plan during labour.
STEP 6: If You Want Alternatives, Ask Your Doula
Perhaps you do not like the idea of a certain “routine” hospital procedures or perhaps your care provider is offering tests and procedures you are not sure you need. Maybe your care provider has suggested something which does not seem in line with your birth plan. Whenever you receive advice from your health care provider which may limit your options or alter your birth plan, it’s a good idea to check in with your doula. She can, at the very least, support you emotionally if you are upset by a change in plans. However, doulas are also masters of alternatives, particularly when it comes to keeping childbirth and pregnancy “natural”. She may be able to suggest other ways in which you can achieve your birthing goals, explain the reasons behind your care giver’s advice, refer you to someone who can help you with your dilemma, or provide information which may alter your perspective on the decision you are facing. Should you decide to act against your care provider’s medical recommendation, your doula may also be able to suggest ways of communicating the importance of your wishes to your care provider in order to enlist their support of your decision.
STEP 7: Notify Your Doula When You Are In Labour
You do not need to wait for the 5-1-1 or 4-1-1 or any other point in labour that your care provider tells you is the appropriate time to call. You can tell your doula you think you are in early labour, you lost your mucus plug, your cervix is soft, you had a stretch-and-sweep, you had diarrhea or any other pre-labour signs. It can be good for you to have someone to share these changes with and to seek reassurance if you are not sure whether your labour has started. In fact, I personally prefer getting a warning that labour may start soon so that I have extra time to get ready to be called to a birth. You can call your doula to come to you before you are in active labour, while you are still labouring at home (if you are planning a hospital birth) or while you are experiencing prodromal (prolonged first stage) labour.
STEP 8: Enjoy Benefitting From Doula Care
Let your doula make your partner a sandwich while he / she holds your hand during contractions. Tell her when you are feeling uncomfortable and ask her what you can do to ease the discomfort. Talk to her about your concerns or ask her questions if they come up. Get her to fetch you a drink, some ice, a wet cloth, some essential oils or other birth props. Have her draw you a bath, massage your back, or sit with you while you fall asleep. Ask her to take pictures of your birth. Enjoy her company between contractions. Having a doula at your birth is really what you want to make of it! The word doula comes from the Greek word for “female servant / slave”. How often do you get the opportunity to enjoy having a servant’s help? Let her help you during labour and do not apologize or feel bad about it. You are doing hard, miraculous work. You deserve to take it easy and have a positive experience. That being said, your doula is not actually a slave whom you can mistreat, so please act politely and respectfully towards her whenever possible. One further thing you should know about doula care is that doulas will not tell you what to do. This is why they are not “birth coaches”, they are support people. They also will not advocate for you. Your doula’s role is to facilitate communication by helping you to learn the skills you need to advocate for yourself. Your doula wants you to be in charge of your birth.
STEP 9: Meet With Your Doula Postpartum
After the birth, you will be busy with a new baby. You may be tempted to put off or skip the postpartum appointment with your doula. However, the postpartum appointment is part of most doula’s services for a reason! Your doula may have great tips on breastfeeding or know who you can contact with your concerns, so especially if you are struggling with learning the art of breastfeeding, meet up with her. It can also be a great chance for you to ask questions about events which occurred during the birth. Since she was there and her focus was on you while you were in labour, your doula is a good person to ask. The postpartum appointment gives your doula the chance to talk to you and see how you are feeling about your experience. This can give her clues as to what resources, if any, you may need in the postpartum period. The postpartum appointment also allows you and your doula the opportunity to see each one last time. It can be nice for both parties to review the birth, reflect on the experience, and have closure.
STEP 10: Keep In Touch With Your Doula Postpartum
Most doulas also have acquired a fair amount of knowledge about infant feeding, baby care and development. I include, as part of my doula services, the option of contacting me any time in the first year after the birth by phone or email. If you have questions about baby care, breastfeeding, postpartum body changes, your birth experience or your feelings after birthing your baby, feel free to contact your doula. She will probably not be available for in person visits or around-the-clock talk time as she was when she was on-call for you (you have to pay for that!), but she may be able to help you over the phone at a mutually convenient time or to answer your questions via email. If you anticipate or find that you will need a lot of support in the early postpartum period, you may want to consider hiring a postpartum doula. But that’s a whole other manual!
I hope this guide has helped you to think about how you can make the most of having a doula with you during your birthing journey. I wish you the best of luck with your new “purchase”.