“You Don’t Really Need a Doula”

Most of the time, when I get a call from a potential client looking for services, the first words out of her mouth are, “My practice gave me your number.” Her midwife or doctor, discussing her birth wishes during a routine appointment, said, “Here, call our doula. She’ll help you.”

Every now and then, though, I’ll hear something more like, “I hope you’ll work with my midwife. She said I don’t really need a doula – that if I want one and can afford it, that’s alright, but she’ll do everything a doula would do. I still really want one, though. Do you think that’s ok?”

This boggles my mind.

Almost always, a doula is a welcome addition to a birthing woman’s care team. In a hospital setting, the doula, the midwife, the doctor, and the nurses all have different roles. The doctor or midwife’s primary job is to attend to the medical safety and wellbeing of the mother and baby. The nurse’s role is to track a mother’s vitals and labor progress, and report to the doctor or midwife any information that may mean that this birth needs help. She may be offering this care to three people at a time, and might see a dozen or more birthing people in the twelve hour shift that she’s there. The partner’s primary role is to love the mother in whatever way comes most naturally. It’s the doula’s role to provide one-on-one non-clinical support throughout labor. This might mean offering simple comfort measures, suggesting position changes, words of encouragement, information for decision making, or just keeping the space calm and quiet – whatever the birthing person needs.

Usually, the doctor or midwife is most actively involved in the “home stretch” of labor, when the baby is about to be born. At the time they are most needed, a midwife is paying attention to many things at once. Their internal dialogue sounds something like, “How’s the baby’s heartrate? Does it seem like the baby is ok? Yup, looks good. How much blood loss is this? Some, not too bad. What position is this little one in? A little crooked, but head’s moving out just fine. Good. How’s this perineum? Give it good support so she doesn’t tear… Where’s that olive oil? How’s mama’s heartrate? How’s her blood pressure? Ok, all is well there. Oh, this fluid isn’t looking so clear… how’s baby’s heartrate now? Went down a little, coming back up fine. Good.” There are a hundred thoughts at once moving through the practitioner’s head.

At the same time, out loud she’s saying, “Ok, Jane, you’re doing fine, just little pushes now. That’s good. You’re doing great.” When something doesn’t look great, which can happen suddenly, she’ll know exactly what to do for the safety of mother and baby. The biggest work of the doctor or midwife happens in short, intense, highly-focused bursts. Like Olympic athletes, they stay calm and make it look easy only because they’re very good at what they do. If they’re a hospital practitioner or in a busy birthing center, then after this birth, they may be called upon to do the same thing six more times while they’re on call in the next twenty-something hours. In a homebirth setting, she’ll need to rest up and practice good self-care in case this is one of the weeks that all four of her current clients go into labor right in a row.

The doula’s work happens in longer stretches of energy and effort. We aren’t responsible for checking blood pressure or doing cervical exams. Though this information is beneficial for those responsible for a mother’s medical wellbeing, those tasks fall outside of our doula role. Our job is to tend to labor support. Prenatally, we spend our hours getting to know you and your wishes for your birth. We talk at length about your hopes and fears. We talk about what calms you when you’re feeling scared, or perks you up when you’re tired. We’re available every day to answer your questions. We learn what is most important to you for this birth, and support you in learning how to help that happen. We spend long hours in helping you get through early labor, when it’s too soon to go to your birthplace or call in your homebirth attendant. We help you figure out when it’s time to call your doctor or midwife, and when it’s time to go to the hospital. We make sure your partner is rested and nourished. We help you communicate with the people who provide medical care for you and your baby. We provide physical and emotional comfort when labor gets intense. By the time your baby is emerging and your trusted caregiver is most needed, the bulk of our work is done. Supporting your labor up to this point might wear me out, and that’s ok. That’s what I’m there for.

For a primary birth attendant, whether doctor or midwife, to practice both as doula and perform in their own role would be irresponsible medicine. Prenatally, it would be foolhardy for your doctor to spend the fifteen minutes he has with you to talk about what calms you on a stressful day instead of talking to you about your latest bloodwork and your baby’s growth. In labor, there is no way one person alone could maintain hip squeezes, breathing through every contraction, and giving pep talks for twelve hours at a stretch, and still remain sharp-witted when their knowledge is most needed to ensure that all is well. From a simple logistical perspective, it’s impossible to support someone’s perineum and also whisper in her ear and wipe her brow with a cool cloth at the same time!

A good doula knows that when a medical judgement call is in order, that’s outside of a doula’s scope of practice. In that moment, it’s the doula’s role to stay out of the way, and to help the birthing couple to understand what is happening and why. Likewise, a supportive practitioner knows that when doula support is desired, having a qualified doula on the team is only going to serve to make the person in his or her care happier with her birth experience.

So, if you’re one of the lucky ones who has found a practitioner who says, “Here, call our doula,” cherish them. Know that your care is in excellent hands. You’ve found a practitioner who cares about your wishes and wants you to be happy with your birth experience. And if yours is the practice that says, “Ugh, I don’t like doulas,” or “Don’t call a doula, because I’ll do everything a doula would do,” I encourage you to question why wanting this support for yourself would ever be considered a bad thing.

You deserve a birth you feel good about. You, your doctor, your doula, your midwife and your partner are all playing different positions on the same team. We’re all in it together. Everybody wins.

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