A Day in the Life of a Doula
26 Nov 2013 2 Comments
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My alarm rings at 6:30, and my morning begins with coffee with my dear, counting our gratitudes and mapping out the day.
By 6:45, two boys are on their way to high school, and depending on the day of the week, up to four more members of the household are out the door by 7am, on their way to work or school.
I have fifteen minutes to check email and answer any texts that came during the night before waking the youngest, getting her ready for school and out the door while getting myself ready for the work day ahead.
Morning prenatal appointment at 9am, followed by an hour of phone time. I check in with mamas who had doctor appointments in the last couple of days, check in on the two mamas who had babies last week to see how they’re doing. In the afternoon, I have an hour for updating my records on the computer, getting insurance invoices together while I eat lunch, a phone consult with a doctor at 1, and a new client interview at 2.
3pm, I pick my daughter up from school, come home to say hi to the boys, oversee homework, and then get the grocery shopping done for the next few days.
Back home at 5, I start dinner for the family. We sit down together, our family of 8, as often as we can. Afterward, depending on the day of the week, I might have a client appointment, or a class to teach. There’s navigating the picking up and dropping off at various lessons. On other nights, there are choir concerts, school plays, PTA meetings.
Back home in the evening, there’s laundry to be done, household needs to be tended, and precious time to spend with my beloveds. In the spaces between, there are bills to pay, a dentist appointment, errands to run, a movie I want to see, friends invited over, family members to connect with, and so on. At the end of the day, today’s undone “to-do’s” are added to the top of tomorrow’s list.
Lather, rinse, repeat.
Or, none of the above. Any day, any time, no matter what I may have planned, I could lift right out. When the “come now” call happens, at least once a week, my life screeches to a halt as I make a quick change, grab my birth bag, and get in the car. I might be out of bed in the middle of the night. I greet the sunrise through a hospital window, bleary-eyed, having spent the last twelve hours with a laboring mama. My sitter gets a 6am wakeup call, asking her to step in where I cannot, to tend the morning in my absence. My clients get last minute calls to say that I won’t be seeing them today. My family might move through the day without me, while I miss the school play, the dinner guests, or the tucking in at night.
I’m often asked, “Isn’t that hard? How do you do it?” In my view, I’m the lucky one – I’m getting to do as I love. My family’s needs for food, clothing, and shelter are met by my getting to live my passion. Sometimes, I might have a pang of, “Oh, I wish this was happening on a different day”, but when I’m present at a birth, most of the time I’m not thinking about being anywhere else.
Committing to someone’s birth means giving them the privilege to take the reins over a day in this precious, beautiful life of mine. I get the blessing of being part of a miracle. It’s my family that pays the price. It’s the people I love who have learned that I may or may not be home when they get here. I may or may not be at the concert, the Halloween parade. The boys might have to make dinner. The laundry might wait yet another day. My kisses and “Good night, I love you” might be by text. It’s my dear friends who accept that I may not make it to the birthday party. Inviting them over is always iffy. My mother’s phone call to ask how I’m doing might go unreturned for two days. That these who are so dear to me love me anyway is my greatest treasure.
Without their acceptance, flexibility, and support, I couldn’t do it at all. For the people who love me, I am truly grateful.
Beware the Hive Mind!
11 Nov 2013 8 Comments
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A stranger on the internet says: I chose a great birth center to have my baby in, but as of this morning they say that I’ve risked out. I don’t want to have my baby in the hospital. So, I’m reading a few things about unassisted homebirth, and I’m thinking that my husband and I can do this ourselves. We’re planning to call the paramedics when I’m delivering so that they can be there to help.
A hundred people in reply say: Heck yeah! That’s a great idea! You can do it! Don’t let them bully you!
Another stranger on the internet says: My sister’s doctor says that she needs to be induced tomorrow. I’m trying to talk her out of it. How long should I tell her she can wait?
Another hundred people say: Tell her not to show up! Wait as long as she wants. I know someone who went three weeks after her due date, and she’s just fine!
And here on the other end of the screen, I sit on my hands.
I can’t believe that I even need to say that this is a bad idea on so many levels.
We have NO other information about these mamas. We don’t know why the practitioner that she knows and has chosen to trust with her medical care is advising her to make this decision. We don’t know what her birth center has said, or why the OB is concerned enough to think that the baby is suddenly safer on the outside. We know nothing of test results, or mama’s health, or signs that the baby may need help.
As a birth community, when we advise blindly to ignore medical recommendations, we are just as much in the wrong as the practitioners who apply all interventions to everyone regardless of need.
As doulas, childbirth educators, or even online birth junkies, it’s great to encourage and support. Mamas no doubt need the community around them who is willing to say “You are so strong! You can do this!” Yes, we are in this together seeking to learn, and sometimes, we might know information that is relevant and useful. However – these decisions should never be left to the opinion of strangers on the internet. When we cross the line into saying, “Don’t listen to anyone!”, we are taking the risk of jeopardizing the wellbeing of a mother and baby we don’t know. This is a serious breech of ethics.
We may be a lot of wise women, but we do not possess the collective wisdom to know what is best for a person that we have never met, that we cannot see, who has been advised by a practitioner that we don’t know, about medical facts that haven’t been shared.
My answer?
Mama needs to talk with her practitioner. Ask the benefits. Ask the risks. Ask the alternatives. Ask if doing nothing is an option. Then, make her own best choice. No hive mind needed.
The Birth of a Mother
25 Oct 2013 4 Comments
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“That’s it, mama. Good. Just like that. That one is done. Let that one go. Rest in between”, I say softly.
She’s been laboring for hours. When her birthing time began this morning, she was antsy with excitement when she called to let me know. She’s been preparing for this day for months. She read all of the childbirth books, the baby care books, made lists of names and things to buy. She had taken weeks of classes, and for the last several days was well past the point of taking in even one more word. She had become a weeping ball of baby and impatience. Now the time had come, and “ready” didn’t even begin to cover how she felt. She was chatty and bubbling as she talked through the contractions that she described as “really strong”. I thought to myself that if she was still able to talk, she had no idea yet what “really strong” would look like. That moment had yet to come, though it surely would.
The mood has shifted now. There’s no more chatter – only intervals of hard work and of rest. The daylight has passed, leaving the room dark and quiet. The intensity that she feels in her body is breathtaking, consuming all of the energy she has. I hear the subtle shift in her breath that signals that the next wave is beginning. She’s hot and trembling, and nauseous and exhausted. This isn’t fun anymore.
“You can do this. You already are”, I whisper. “Your body knows how. Your baby knows how. All is well. Everything here is exactly right.”
The word “labor” means work. The work of labor is to open. It’s the opening of a mother’s body, her flesh and her bones, to make room for the baby to pass through. It’s the opening of her heart, to love this new human being deeply and unconditionally. It’s the opening of her relationship with her partner, to love one another in this new territory of parenthood. It’s the opening of her life. It’s the wide-open stretching of all that she is, to become born anew in the next step of her life journey.
As I hear her moaning grow deeper, I know before she does that the moment of meltdown is now drawing near. It always does – in hundreds of births before, I’ve seen that every birth has one. We are closing in on the time when she will reach the edge of her very being, and will need to call upon every resource that she has. It’s the moment of “I can’t do this anymore! That’s it, I quit! I’m done, no more!” Sometimes it’s loud and tear-filled, sometimes the words are spoken only in a whisper, and sometimes, it happens silently in her head. I don’t know what form it may take – I know only that it will happen. As part of her labor, it must.
This phase of the last few hours of pregnancy is a time of in-between. It is neither here nor there – on the verge of bringing forth life, a mother is at once her old self and her new self. One foot is in the only world she has ever known, and the other is in a new uncharted territory. Standing at the edge of a new life – it is a moment both welcome and terrifying.
The medical, clinical, scientific terms for this window of time are easy enough to learn – transition, contractions, oxytocin. Websites are full of advice that says, “The good news is that if you’ve made it this far (without medication), you can be coached through this stage with constant reminders that you’ve done a good job and your baby is coming soon.” The messages are always that what is happening in this moment is temporary and insignificant, so don’t wimp out. Lighten up, honey, you’re just having a baby.
What’s missing from our language, our culture, and our scientific understanding is reverence. To give birth, whether birth happens at home in a tub or in an operating room surrounded by beeping machinery and medical personnel, a woman must journey to this place between the worlds. This meltdown is the work of her soul as she approaches the place where the veil between-here-and-there has grown thin, to reach through and bring back with her the new soul that she has invited into her life.
When we allow the reality that the heart of this holy moment is spiritual as much as physiological, we create room for awe and wonder. Whether or not those who surround her recognize it, to be present with a woman in this time is to stand on sacred ground. This uncertain phase of in-between is a necessary event, essential to the rebirth of a woman as she becomes Mother. It is an ancient understanding that the midwives once knew, now forgotten and shrouded in the quantifiable measurements of thinning and dilation.
This is the transition of modern civilized woman into primal birth goddess. Logic, ration, and reason melt away. The intellectual medical vocabulary of hormones and timing and measurement become useless and without meaning. There’s no thinking, no pretense – just the genuine, undiluted energy of a woman giving birth. It is raw and powerful. Though profoundly beautiful, it is intense and sometimes unlovely.
My hands press her hips, stroke her back, smooth her hair, as she chants “I can’t, I can’t”. She can do it, of course, just as her mother and sisters and a thousand grandmothers before her have done. This is the sacred struggle of every laboring woman, standing toe-to-toe with her own fears as she battles through her resistance. It is the time when every thought she carries that no longer serves her, every story she’s heard that has undermined her belief in herself, every fear she’s never voiced is released. They are shed through her tears, her sounds, her fluids, and her blood. She quivers and shakes with the energy and the effort of letting go; of sweet surrender to the life force larger than herself. This round, weeping woman is battling her own monsters as she undergoes the alchemy of complete transformation.
She has reached the magic threshold where she makes the inevitable choice, as women throughout time have done, to take just one more step into the mystery. She becomes all elements embodied; the pure channel for a new soul to emerge from the waters of her belly, through the ring of fire, arriving on Earth to take her first breath. She returns from the brink, victorious, with her wet, squalling newborn daughter naked on her skin, and her newly-born mother-self rising up as never before.
I watch her face, moments before twisted in pain, become alight with joy and ecstasy as she falls in love with her tiny baby girl. “You’re here, oh look, you’re here! You’re so beautiful! I love you! We did it!” It hasn’t been easy, but it has been worth it. It always is. She knows, now, down to her bones, in a way that can never be taken from her, the story of her own courage and strength. She is not a “poor thing” – she is a mighty warrior.
I am grateful today for her safe passage as she joins the sisterhood of women who have traveled this rite into motherhood. I am grateful to be part of the sisterhood of women for whom holding space for this time of in-between is their life work, just as it was for my great-aunt midwife before me, and countless hundreds before her. I am grateful, always, for the opportunity to offer love and affirmation in the face of such vulnerability, for the gift this birth has given me to witness a woman reaching the end of all that she thinks she knows, and to see her through to the other side. I return home knowing that I have, once again, been witness to a miracle.
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Dealing with Client Debt
26 Sep 2013 2 Comments
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Marie asks: What does one do when a client doesn’t want to pay after services have been rendered?
Nobody likes to be owed money, and nobody likes to owe someone else. Just the thought of conflict about payment is pretty uncomfortable.
For many doulas, being in this situation just one time is enough to learn a good lesson about making sure our agreements are clear to begin with. It might be time to revisit your service agreement, and make sure that your payment structure is clearly outlined. Many birthworkers have a specific date by which payment is due in full before on-call time begins. If the risk for the client is that nonpayment means that services won’t be rendered, it’s far less likely that you’ll find yourself in this situation again.
Many doulas have statements in their client contracts that also outline what circumstances, if any, would result in a refund of fees, or in having no money due. Some of these situations include failure to provide services, or failure to provide adequate backup support if the doula is suddenly unreachable or unavailable. Some doulas also include clarifying statements about fees remaining payable in the event of an undesired birth outcome, or unexpectedly rapid labor, or other circumstances beyond the doula’s control. Having a clear service agreement can help avoid a lot of headaches and uncomfortable conversations.
Now that you are there, though, there are a few reasonable steps that can be taken. Step one would be to simply ask for what you are due. Acting sooner is usually easier than waiting. If you’re doing a postpartum followup visit at home, you might mention when scheduling, “Oh, and I can pick up a check from you while I’m there. Do you need me to look up your balance and text that to you?”
If you won’t be seeing her in person, email might be another option. This is a good step to take when it has been a longer time, as well. Reach out in kindness. Act with the intention of clarifying your agreement with one another, with willingness to assume the best of intentions. Speak to the other person with the belief that he or she is responsible and reliable, and likely to keep her word. This intention will come across in the words you choose. “Hey, Lisa! Just checking in and following up on your file. It looks like your balance is currently $—, and our contract says that balance is due by 2 weeks after your birth (or whatever your agreement may have been). With a new baby in your world, I’m sure things have been really busy! When you have a moment, please, would you let me know when you’ve dropped that in the mail to me? Thanks!” Make sure to include your address, and information for how any checks should be made out. Sometimes, people lose track of their documents, and are embarrassed to say something as simple as “We forgot how much we owe you”. They might be hoping that you have a step in place for when that happens. In cases like these, good follow-through on your end will be enough.
If it isn’t, a second attempt at communication may need to be more direct. Consider sending hard-copy mail in addition to any e-mail. Keep it simple. This is not the time for long letters or an emotionally reactive plea. Keep it factual. A straightforward letter or an invoice showing balance past due and a “pay by” date is a good idea at this point. Include a self-addressed stamped envelope. Send it certified mail, and keep the receipt.
If that doesn’t work (and goodness, let’s hope it would!), the following step would be to decide how important this is to you, and how much energy you are willing to invest. Decide whether pursuing the debt through small claims court would be worth your time. Most small claims courts have a maximum allowable limit of a few thousand dollars. Make sure your records are prepared – what your agreements were, any signed documents you have in your possession, and copies of any communications you may have sent. Your local county clerk can tell you what steps are necessary to file a claim, and the documents you may be asked to fill out are pretty simple. You’ll need your clients name and address. This may take some time, and could result in needing to show up in court, though they could decide to send payment as soon as they get the notice.
Again, use this as a learning opportunity. Create good documents for yourself to share with your clients, with your fee structure and payment dates that are clearly outlined. With hope and good preparation, you’ll never have to go through this again!
When Dad is Disconnected
23 Sep 2013 1 Comment
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Kara asks: I am wondering what you do when a father is not very supportive of the labouring mom, and even goes as far as to judge and try and make decisions for the mom? How do you keep mom empowered?
Relationship dynamics are often difficult to navigate. This is especially true when we, as doulas, are present for a only short time with people who were together before we came on the scene, and will be in relationship long after we are gone.
First – check yourself. Where might you be in judgement of this couple? We all judge others. There’s no sense in pretending that we don’t. Simply being able to honestly say to ourselves, “Wow, I’m judging that. That pushed a button for me, and I’m having some feelings about it” can prevent us from letting our own judgement spill over into the doula/client relationship. Thinking to ourselves, “That’s different than what I’d prefer for myself. This isn’t my relationship. That’s ok” can help us let that go.
Then, consider the culture. Does this family come from a tradition in which men are not typically involved in childbirth? In getting to know the couple prenatally, ask her what she thinks of when you say the word “support”. What does support look like to her? What support does she expect from you? How does Dad see his role? Consider, too, what Mama thinks support from her husband will look like. Does she seem to expect that he will be affectionate and hands-on, or do they seem to be ok with his being on the sidelines, involved in his own way? Sometimes, the couple expects that the doula will be there for the intensive hands-on physical comfort, and the affirmative emotional encouragement. Other times, they expect that the dad will be the one in this role, and the doula will be on the sidelines offering occasional suggestions while sitting on her hands. Both of those options are do-able, as long as we know what the expectation is. What is it they want, need, and expect?
It’s important to understand what she thinks empowerment means. While some families make decisions by what Mama desires for herself, others seek mutual agreement, and in others, it’s the man who has the final word for his wife. She may be expecting that he will be the one to make decisions. As strange as this may seem to doulas who may come from another way of thinking, if that’s the family’s comfort zone, it is up to us to accept them for who they are, and honor that. We may need to work within this dynamic by presenting information, and talking through decisions together. Or, it might be true that he thinks that his role as protector/defender means that he has to know the “right” things to do or say, even when he really doesn’t. One way to help a dad through this is to talk about it. Let him know that you want him to be involved to the fullest extent that he is comfortable. Ask him if he’s ok with your making suggestions, or modeling a comfort measure (such as hip squeezes) and handing it over for him to do. Sometimes, he may feel less lost and more supportive if he knows he has a specific job to handle.
And lastly, we have the scenario in which Mama knows what’s best for herself,she knows what she wants and needs, and he’s just not willing to provide it. The only power you have as doula in this case is to decide what you will do. You can only do your best to offer support. You can’t make him not be a jerk. She chose to have a baby with him. She chose to have him there for this birth. You are not responsible for their relationship. The best you can do is show up. Give her encouraging words. Make suggestions for her comfort. Mentally zip a teflon shield around yourself, so that his annoying tendencies don’t get to you. Brush it off as much as you can. Letting him know that he’s getting to you may give him a greater sense of power, and make his jerkiness even worse. Seek out your own support people and vent as much as you need to. Be gentle in your expectations of yourself. Don’t expect yourself to fix something that you didn’t cause – just know that in being there and doing your best, you’re making a difference. That’s enough.
Go Ahead, Ask Me Anything!
17 Sep 2013 3 Comments
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Four days ago, I got a message from a lovely midwife in training asking if I would share my thoughts about birthworkers, privacy, and social media. In the four days since then, the resulting article has become the most viewed blog post I’ve ever written. I’ve decided to take an “Ask Me Anything” approach for a little while, and see what comes of that. Sharing doula wisdom and experience is, after all, my goal here. So, what questions do you have? What challenges are you facing that you’d like to hear addressed? What are you curious about? I’d love to know!
Doulas and Social Media Disasters
11 Sep 2013 32 Comments
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In the last five years, the social media explosion has made it easier than ever to keep in touch with friends and clients, network with colleagues, gather the latest research in the news, and pass along information. Having a strong online presence is a necessary part of growing a decent birthworker business these days. With this ease of info-sharing, however, a crisis is rapidly developing around birthworkers, boundaries, and privacy.
In my local community, it happened recently that a grandma learned her brand-new grandbaby’s name and gender through a post on facebook. As awkward as that may seem, it becomes ten times worse when we throw in the fact that the post was created not by the new parents, but by their doula! It happens all the time – excited doulas, midwives, and even birth centers have pages full of “John and Mary welcomed baby Ian this morning! Mary worked for a hard twelve hours, but she did it all naturally! Good job, mama!” Now, John and Mary may have appreciated that their doula was so happy and proud of them, but my guess would be that Mary would have wanted to tell her own mother for herself, first.
I’ve seen pictures on the social networking pages of doulas who live half a world away from me that show baby skin-to-skin with mama just moments after birth. They proclaim, “Congratulations, Julie!”, and instead of thinking, “Yay, go Julie!”, I think “Hi, Julie, you don’t know me, but I’ve now seen your breasts. Is that ok with you?”
With the best of intentions for respecting privacy, even a well meaning “Off to a birth!” or “Wow, great birth this morning!” can go wrong if the vaguebooking doula happens to be a friend of a mutual friend with the birthing woman. If Sarah used me as her doula and followed me on Twitter while we were working together, and sent her friend Laura my way months later, she probably knows that I’m on call for Laura, and can easily guess whose labor I’m on my way to. Even if I’ve said only positive things, Laura might not want her friends to know that she’s in labor, or thinks she might be, before she has told them herself. I may never know who has friends in common with me through other online groups. The world is small, and getting smaller with all of the ways we have available to be connected.
Attending a birth is an intimate experience, worthy of respect for privacy. In my thinking, it is a mama’s own decision, and no one else’s, to choose when to let the world know that her body is laboring, that her baby is here, and that her birth went well (or didn’t). It is her right, and not mine, to announce her baby’s gender, and the name they’ve chosen, and whether or not her baby came out of her vagina. It is as important to preserve the intimacy of her experience in our online interactions as it is to not share her birth story with others in person without her explicit consent first.
We may be excited, or sad, or bursting at the seams with good news, and that’s completely understandable. Of course we care deeply that all went well. Holding space for someone else’s joy is a privilege. Learning to contain in our hearts the love and happiness we feel, without allowing it to spill out from our fingertips, is part of walking the path of doing this sacred work. Protect the birth story. It’s how we do what we do.
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A Quiet Moment with my Last Baby
05 Sep 2013 Leave a Comment
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Hey, Chickpea.
It’s the first day of school, and the five other kids in our house were out the door half an hour ago. You were up as early as they were, so excited. Your school day starts later than everyone else’s. “So unfair that I have to wait!”, you say.
I am grateful that your morning needn’t be so fast. Little caboose, you’re so often the one along for the ride while we attend someone else’s recital, or game, or show, or event. Just for this morning, I am grateful for the time I get to enjoy you, all to myself.
You, my girl whose tongue wags at both ends from sunup to sundown. So often I find myself saying, “Hang on, hang on! I can’t hear you when someone else is already talking.” I am grateful this morning for the time to turn my undivided attention to what you have to say. You, with always one more question.Yes, I did notice that you set your alarm clock all by yourself. No, I don’t know if third grade teachers let students use calculators. No, I don’t know if third graders get to draw on the first day, but I hope they do, too. Tell me for just another minute about how much you love to draw; tell me again how excited you are about the new big box of crayons you have this year, and how you might share them with others, but only if they agree not to break them or peel off the paper.
You with your sense of style on proud display with your new neon hightop sneakers. Braving the mall with you to find those was totally worth it. You’ve picked out every outfit you’ll wear from now through Monday? I can’t say I’m surprised.
Yes, Azure, I can think of a book you might like, let’s go into your room to see. I love hearing about your newly discovered passion for reading, and listening as you pick out your book to pass the next hour while telling me that though you love chapter books, you really appreciate it when they still have a few pictures.
This morning it’s so hard for you to wait, and so hard for me to hurry. I’m cherishing the minutes that I get to enjoy you, my last baby, at eight years old.
“Natural” Labor Induction?
13 Aug 2013 5 Comments
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In the past two days, a lot of buzz has been going on about a study that linked labor induction to increased rates of Autism. The response to this has been interesting. There are those who say that this simply means that more research needs to be done, and those who say that suspicion has existed all along that labor induction and augmentation are perhaps higher risk decisions than originally thought.
I’m also seeing, within the natural birth community, a lot of feedback about using herbs and essential oils for “natural labor induction”, promoted as though these options are much better or safer. Here’s where I part ways with the pack.
Induction is induction is induction. Making labor happen before mother and baby are both ready is, in and of itself, a risky procedure. These studies aren’t just showing us that Pitocin is risky, or that Cytotec or any other labor-inducing medications carry risk, but that forcing a baby to be born before the baby has initiated labor is a procedure that carries risk.
Though medical science has developed ways of getting the baby born when a concern is present, science has as of yet found no explanation for exactly what makes labor begin on its own. What we do know, from studies in recent years, is that the last stage of fetal development happens in the baby’s brain, and that this triggers the cascade of events that leads to baby being born. The most recent study, released yesterday, shows that induced labor may increase the likelihood of a child later developing autism.
Going past a predicted due date is, for many, a problem with impatience far more than it is one of medical safety. Science has shown that the length of a normal pregnancy varies by up to five weeks. Going past a due date by two weeks is perfectly normal. Being “tired of being pregnant” is not worth the risks involved with forcing labor before the baby and the mother’s body are ready. This is true whether the agent used for induction comes from a plant purchased at the health food store or a chemical carried in a hospital pharmacy. There is no such thing as a “natural” induction – forcing the process of labor is, itself, not natural.
As both a doula and a practicing herbalist, I’m often asked if there’s anything one can do to get labor going. My answer is to rest and hydrate. Store up your strength. Eat well. Laugh a lot – laughter releases oxytocin and makes you feel better. Snuggle with your partner. Cry if you need to. Do whatever needs to be done to get to an emotionally ok place with being in the temporary “in between” space of growing a baby and becoming a mother. Getting comfortable with the discomfort of the unknown is just one of many life lessons that carrying a baby brings the opportunity to learn. Babies come when babies are ready. Don’t push the river – it flows all by itself.
This is Not the Doula You’re Looking For
12 Aug 2013 15 Comments
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Have you ever heard a “bad doula” story? Chances are, if you’ve been in this field any time at all, you have at least once. She crossed a line, rubbed somebody the wrong way, didn’t do what was expected, things didn’t go as planned… In her own version of the story, the doula may have put her best foot forward. Sure, sometimes we all make mistakes. That’s part of learning and being human. It might also be true that, no matter what she did or didn’t do, this story was not going to have a good outcome in the end. Not every doula is a good fit for every mama.
As we learn, grow, and hone our skills, a really important lesson comes in the form of knowing when to say, “I’m sorry, I’m not the right doula for your birth.” It’s not easy, especially in the beginning. A new doula is excited to have an opportunity to serve as many as she can. She’s eager to meet with new clients, and willing to stretch herself as much as possible to make her mamas happy. The thought of turning a client away is fear-provoking. She needs the experience, wants the income, and has in her heart a desire to be helpful.
Eventually, the lesson comes that we, as birth workers, are responsible only for our commitments. We are not responsible for our clients feelings, or the choices she makes, or her struggles. We are not responsible for whether her birth meets her own expectations. Nor are we responsible, though our egos love to think so, for her joy. We are accountable for our integrity – for doing as we say we will, when we said we would. Nothing more, nothing less.
A big part of showing up in integrity is knowing ahead of time what we can and cannot do. Saying, “That’s beyond my ability”, especially the first few times, is terrifying. The hamster wheels in our head get to spinning. We may think, “What if she doesn’t like me anymore? What if she doesn’t hire me? What if she tells her friends, and then I get a bad reputation? What if she doesn’t find someone who is right for her?” We worry about creating stories of abandonment, or hurting feelings. Doulas are, at the heart of the matter, compassionate people. But, if we truly long to help not just this mama, but the many who may come after her, knowing when to say “no” is truly an act of service within itself.
If we take on the responsibility for the journey of a woman’s pregnancy and outcome of her birth, we have robbed her of the opportunity to claim her own responsibility in creating her birth story. Denying a woman the power of using her own voice and strength is the greatest disservice we can do. The “bad doula” that you’ve heard about? Chances are that she was speaking for the mama instead of encouraging the mama to speak for herself. It’s likely that she was holding herself accountable for this birth, instead of holding herself responsible for support. She showed up in combat gear to do a peacemaker’s job.
On my own doula path, I’ve come to recognize a few red flags that let me know clearly when I’m not the right doula. Other doulas may have their own signals. A few I’ve come to recognize are:
If a mama is…
hoping that hiring a doula is all she needs to do to have an unmedicated birth
not interested in taking childbirth classes or reading books (at least one or the other)
learning all she needs to know from watching birth shows on TV
suffering from unresolved trauma, panic attacks, or debilitating anxiety for which she is not seeking other professional help
working with a doctor she hates and is unwilling to change practitioners
working with a practitioner who has made it clear that he or she doesn’t want to work with doulas
delivering in a facility that has strict policies against what she wants, and she’s unwilling to go somewhere else
planning to accidentally have her baby at home without qualified support
wanting to have uninterrupted hands-on doula support from the time her first mild or erratic contractions begin (even when it’s clear that birth may be days away)
truly terrified of giving birth at all, with or without medication
wanting to be told what to do, rather than given her options and asked for her decision
wanting to be protected from an abusive spouse or family member who will be present for her birth
… then I’m not the doula she’s looking for.
This doesn’t mean that I don’t care. Rather, it means that in knowing my own limits, I’m in a much better position to say “here’s someone else who might be able to really help you”. Maybe I send her toward a great therapist, or a support group, or even another doula who specializes in exactly what she’s looking for. Sometimes, saying “I’m sorry, but no” is the best support that I can offer. Is it easy? Heck, no. My hands sweat and my knees shake, every time. But in the end, I know that in the temporary disappointment for us both, I’ve offered her far greater support than I ever would have if I’d have made a commitment I knew I couldn’t honor. I sleep with a clear conscience, she has the opportunity to get the support she really needs, and all will be well.
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