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What is a Doula? Labor/birth support doulas are trained and experienced labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks, or vaginal exams but rather use massage, aromatherapy, reflexology, positioning suggestions, etc., to help labor progress as well as possible. A labor/birth support doula joins a laboring woman either at her home or in hospital or birth center and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. In addition to emotional, physical and informational support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures. Postpartum doulas are hired to support the woman after birth, usually in the family's home. They are trained to offer families evidence-based information and support on infant feeding, emotional and physical recovery from childbirth, infant soothing and coping skills for new parents. They may also help with light housework, fix a meal and help incorporate an older child into this new experience. The terms of a postpartum doula's responsibilities are decided between the doula and the family. Featured Article about Doulas: How often have you been talking to a first time mom about doula care, and she seems so jazzed with the idea, and then her partner comes along. Suddenly, doula care is a non-option. I’ve seen many a first-time dad look less than thrilled with the idea of doula care. For many of them, a doula seems unnecessary. She is an unnecessary expense and an unnecessary intrusion. She is another stranger to be a voyeur at a private time, another person to boss you around. She is someone who might shunt dad to the side. When addressing dads regarding doula care, it is important to listen to and validate their fears. It is perfectly normal for them to be uneasy and entirely understandable for them to feel threatened. It is completely natural for them to question the cost and necessity of your very existence. That is when you have to convince them. Top five dad fears (not always articulated this bluntly): 1) You’ll make them look bad 2) You’ll exclude them 3) You’ll make them feel dumb 4) You’ll interfere with and control their partner’s wishes at the birth 5) You’re overcharging for something nurses do anyway You’ll make them look bad: This can happen only if a Doula isn’t doing her job. As far as I see it, part of my job is to support and enhance the family bond. My job is to make the dad look GOOD. I will quietly prompt, slyly hand over a Kleenex or a cold cloth, and make sure he gets as much credit as possible. They are the couple, they are the parents. It is not about me. You’ll exclude them: I always endeavor to include the dad to the comfort level of both him and his partner. How do I gauge this? I pay close attention to cues at the birth, and I make darn sure to cull information from the couple prior to the birth. I will ask specifically of the dad at my prenatal visit: What do you see me doing at the birth and what do you see you doing? What do you want to be in charge of? As well, if the mom has indicated a wish for the dad to not be fully included in the labor and delivery, for any reason, I talk to her about dialoguing directly with the dad prior to the birth so that he is aware of her wishes directly. It is their relationship and they have a unique history. I respect that. You’ll make them feel dumb: Again, only if I am not doing my job. In my experience, there is usually a Doctor or Nurse, less often a midwife, who does a good job of making someone feel just a bit dumb at some point during a pregnancy, labor or delivery. They don’t need me adding to that dynamic. My job is to make dad look on the ball, and empathetic, even if it doesn’t come naturally. I am a big believer in always giving dad “the opportunity to save face” in front of his partner. That means I whisper, I pull him into the hall or the bathroom, I am subtle, I make things his idea and I prompt gently. You’ll interfere with and control their partner’s wishes at the birth: Dad’s sometimes think Doulas are the crazy protectors of all-natural birth who will throw themselves over the mother’s body to prevent any needles from entering her, anywhere! Frankly, some Doulas believe that. And some moms want that Doula. But that is not me. Although I have my own, strongly held, well-informed views about the lack of necessity and over-use of many interventions, I also respect very strongly a woman’s right to informed consent and informed choice. The key for me is informed. If she wishes to have an intervention and has been informed of the risks and benefits, and still wishes to proceed, that is her right. It is her birth, not mine, and I have no right to control her choices. I make darn sure to get a sense prenatally of her wishes for the birth and her philosophy around pain control, and his wishes, too. I try to ensure that they are both well informed and aware of non-pharmaceutical options for pain relief. I make sure that I am a well-stocked doula with lots of tricks and goodies to offer relief. I prompt position changes and upright postures. I don’t end up with many epidurals, very little narcotics, and sometimes laughing gas. But it was mom’s choice and she felt in control. You’re overcharging for something nurses do anyway: This comes down to simple misinformation. Dads and moms don’t understand how little time nurses have available at a birth for hands on comfort care. I simply let them know the information. One study put the average that 10% of the nurse’s time at the birth could be spent on hand’s on care. Even the best nurse cannot simply sit continuously with a laboring couple and offer the kind of care a doula can. Even if they wanted to, and I know many nurses who wish they could simply “doula” at a birth, they have many other responsibilities. They have to ensure that the equipment and supplies are set up for the birth. They have to chart and report out to the doctor or midwife. They have to assess the well being of mum and babe throughout. They have to fulfill their clinical duties and to do it well. For that reason, I don’t want to be the maternity nurse, folks; I want to be the doula. Then I get to do the continuous hands on physical, emotional and informational support and none of the other stuff. So, that is my approach when confronted with the wary dad and the eager mom. Sometimes I am not convincing enough. Well, you win some, you lose some. What I have found, however, is that the most resistant dads are usually first in line to call me to come for their subsequent birth experiences. Sometimes the only way a dad can value what a Doula can offer is for him to experience a birth without one. But don’t say, “I told you so!” Happy birthing. Sarah Hilbert-West is a Childbirth Educator, Birth Doula, Breastfeeding Counsellor and Post-Partum Depression Support Group Facilitator. She owns and operates http://www.birthwares.com, offering birth stools, unique teaching aids and useful resources for childbirth educators, doulas, parents, and midwives. http://www.birthwares.com - the site for YOU! |
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