- Bethany Geisel
So what's a DOULA anyway?
Updated: Jul 4, 2019
This is a question we get A LOT. Doulas are slowly becoming more mainstream around the world, but in our little corner of Brandon, Manitoba, sometimes it seems (at least to me!) that that change is even slower. While doulas are nothing new, as women have been supporting other women during birth all throughout history and in every corner of the earth (yeah, it’s true - birth has historically been the purview of #WOMEN, and ‘back in the day’ you would have your midwife as well as several other women supporting and surrounding you, including your
mother, sisters, daughters, aunts, friends, etc). The modern #doula really didn’t emerge until the late 80s with the founding of #DONA (Doulas of North America), and you could start to see women who were professionally trained to provide labour support, rather than simply supportive friends and family (though to be honest - supportive friends and family are super beneficial, too!). There is plenty of reading material out there on the beginnings of the doula profession, so I won’t reinvent the wheel by re-hashing it all here. I will add some links and suggested books at the end, if you want to know more. Suffice it to say, it was the early 90s when the benefits of #laboursupport began to be recognized as have measurable benefit and improving outcomes for women who were birthing.
So what ISN’T a doula? People often confuse doulas with midwives, and ask us if we catch babies. The short answer is no, doulas do not catch babies. Doulas and midwives have roles that overlap in some ways, and vary differently in many, many others (think VENN diagram). Most importantly - doulas are not medical care providers and DO NOT provide medical services such as catching babies, checking heart rates, giving medication, cervical checks, etc, etc, etc.
Doulas do not have medical training, and midwives have extensive medical training. Where there is overlap is the supportive care and emotional support that both provide. But even here, in many cases your doula can give you more of her time and energy, simply because the doulas only priority is supporting the mother - physically and emotionally. Your doula is concerned with helping you to manage each contraction, each up and down of labour, and trying to ensure that you understand what is going on and feel empowered to make your own choices regarding your care during labour. Your doula has no other labouring person to go to, no shift end which would cause her to leave - she is by your side from the point that you need her to be until after your baby arrives.
I like to use a #tourguide analogy. I admit, it isn’t a perfect analogy, but it works and is easily understood. I can’t take complete credit for it, either - Christen Pascucci once said “Think of a doula as a native tour guide through a place you’ve never been before where a different language is spoken. Without a doula, you’ll still get from point A to point B, but with a doula the quality and depth of your experience will be incredibly different.” So, like booking and planning a trip somewhere or a vacation, hiring a doula is like hiring a tour guide for that trip. You can book your trip without a tour guide, absolutely, just like you can have a baby without a doula. The baby is going to come out, at some point. But like booking a trip with a tour guide, having your baby with a doula really enhances and improves your experience. On a trip, your tour guide will look at what you want to do, and suggest ways to make it better - they will suggest places you maybe hadn’t thought of, or they will suggest certain times to visit an attraction. They will know what the best time of day is to go see something, or can suggest alternatives to a certain attraction if it is closed that day or unavailable to you. Your tour guide will remind you of all the things you might need to bring with you, or suggest an item or something to bring with that you might not have thought of, such as an umbrella or sturdy shoes. They know of some of the local rules and can keep you from being surprised at an unexpected fee or a local bylaw that is unfamiliar to you. Your tour guide will also suggest local places to eat that aren’t in the guidebooks, and so on. They will go with you to these places you’ve only read about, and show you little things that aren’t mentioned on tourist placards, or are hard to explain on a travel blog. They speak the local language, and can help interpret for you if something is confusing, or if the translation is a bit off. Your tour guide does their utmost to give you the best experience they can, even when things happen that they can’t control, such as bad weather, closed roads, or closed attractions. And when the unexpected does happen, your tour guide will always have some other suggestion for what to do next or how to still enjoy your experience despite the setback. In the same way, a doula enhances your labour and birthing (and postpartum!) experience. When you hire a doula, they get to know your desires for birth and your wishes for an optimal experience, based on your interests and desires. They give you information on things that you ask about, and suggest things you may not have thought of. You work together during pregnancy so that you are on the same page with your birthing wishes, and so your doula is prepared to help you with how your birth unfolds. When you go into labour, your doula comes to you at your request, and then stays with you to help throughout the birth.
Your doula will be able to suggest things to do during the early phase of labour, help keep you distracted if it is going slowly, and help you cope if it isn’t what you expected. They will help reassure you if you are struggling, and suggest ways to progress the process. Your doula might have a bag of tricks that they use to provide comfort, switching it up if something isn’t working for you, or suggesting a new position to try if you seem uncomfortable (or sometimes, if you are too comfortable!) Your doula will provide physical relief in the form of massage or counter pressure, if that works for you, and will help your partner be a support to you as well, by suggesting ways for them to provide physical support, or help you get some natural #oxytocin flowing. Your doula speaks the “birth language” and can help you understand some of the medical terminology, if need be. And after hours and hours, your doula will still be there, by your side, supporting you and helping you, using her extensive knowledge and skills to give you whatever it is that you need in that moment. And if your labour deviates from what you wished initially, as it often does, your doula will be there to help you and your partner navigate the change, and will still be able to suggest ways for comfort. Your doula doesn’t have an agenda, or anything like that - like your tour guide, she simply knows birth and wants you to experience it in the best way for you, based on your experience. No matter what, your doula enhances your birth for you. Because, after all, it is YOUR birth, and your baby, and your experience that matters.
So that is more or less what a doula does. It’s hard to describe in words what the job is, as most doulas also see it as a passion, or a calling. It can be hard (as I write this after a 20+ hour birth), to really qualify what that kind of support looks like for that length of time, or really say why it is we do what we do. We often hear “We couldn’t have done it without you,” from both mothers and partners alike. Hearing that always makes the hours worth it - even though you, mama, are the true rock star. And, at the end of the day, even after providing 20+ hours of labour support to a mama who had already been in labour for 16 hours, before she asked me to join her, I still would choose to do this over everything else. Because it is through this labour experience where you see people at their most vulnerable, but where you also see them at their greatest strength, and with incredible power. And seeing the quiet calm of a mama greeting her baby for the first time, or a partner with tears in their eyes as they watch the exhausted but triumphant mother with the new little one, and observing the new baby open their eyes and take in their parents - and as a doula, having even a small role in that process, is incredibly humbling and a great honour. You did it, mama. You did this, and I just held you up so you could see that you could.
Further Reading (this is just a small selection) About The Origins of Doulas
https://www.dona.org/the-dona-advantage/about/history/ https://www.curioushistory.com/historical-origins-of-the-doula/
The Doula Book by John H. Kennell, Marshall H. Klaus, and Phyllis H. Klaus The Birth Partner by Penny Simkin Birth Ambassadors: Doulas and the Re-emergence of Women-supported Childbirth by Christine H. Morton and Elayne Clift
Evidence on Doulas https://evidencebasedbirth.com/the-evidence-for-doulas/
https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
https://www.dona.org/what-is-a-doula/benefits-of-a-doula/