The Role of a Birth Doula: A Breakdown

Image above of Doula Nana with a laboring client. (Used with permission.)As a postpartum doula, I get asked many times if I am there for the birth. I think many hear the word "doula" and assume it is in reference to birth. I love that birth doulas are becoming more recognized, but birth doulas and postpartum doulas, while both support the family, also have two different roles. Below is a piece my friend and partner, Connie "Doula Nana" Machan, wrote on her role as a birth doula serving in great Cleveland area.A Birth Doula Does What?A birth doula is not a midwife nor a nurse. I am a doula and happen to be a retired Registered Nurse. My role, as the term doula means, is to serve women. I do this physically, emotionally and educationally before, during and shortly after, labor. What does this look like? Because most doulas have similar approaches I'm going to share with you a typical scenario which will give you a peek into what it is that I do.First An Interview:I usually meet with couples several months before their due date, often at a coffee shop, for an informal interview to see if we would be a good fit. However, I have been hired by ladies only a few months pregnant to ones literally days away from birth, so, although it's never to late to engage a doula, having her expertise and ear as one goes through the last four to five months of pregnancy can be invaluable. After the interview, parents have a welcome folder which includes my contract and they can decide to send a “save the date” deposit, at which point they are placed on my calendar.During Pregnancy:I have gone to the hospital to visit a client with complications, attended doctor visits when important medical decisions were being made, helped a sick client in her home when her husband was out of town and her daughter needed dinner and bedtime books, and researched multiple ultrasound findings to assure and enlighten worried clients. These would be some of the advantages to securing services early in your pregnancy.First Prenatal:Around thirty-two weeks we arrange a meeting in a couples' home to start working on their birth plan. This is often an educational session with lots of questions and answers, discussions of fears about labor, exercises both on paper and on the floor as we start the preparation for labor. I and many other doulas, work with a Rebozo, traditional Mexican scarf, to “sift” and help relax muscles and ligaments as well as Mom herself! All these exercises are taught to all and usually end up with all of us laughing on the floor! We also go over decision making and do a Loving Kindness Meditation together for baby as well as the couple themselves."This includes discussions about the importance of oxytocin and dealing with curiosity and anxiety."Second Prenatal:This meeting is also done at your home at around thirty-seven to thirty-eight weeks.. This session is all about Labor Preparation. We review the birth plan and discuss recent midwife/dr. appointments. Current concerns are addressed as well as how we will proceed from here. This includes discussions about the importance of oxytocin and dealing with curiosity and anxiety. We review the Road Map of Labor and do a dress rehearsal for Labor Day in their home.Partners get a special chapter in one of my recommended books to read to help them prepare as well as a brief tutorial in acupressure which I also use in labor. Acupressure can be used to alleviate a mother's symptoms and ease some of labors pains. By the end of the second prenatal, clients usually report that they are feeling prepared and excited for labor to begin!On Duty:From week thirty-eight I'm on call for ladies 24/7 by text or cell. We text often so I'm updated as labor begins to unfold. Sometimes, I go to the couple's home once they've been laboring together, at times I've ridden to the hospital during labor because a partner needs to drive and I need to help Mom keep her focus, especially if she's closer to delivery than she realizes!At the Hospital:May I first clarify that many couples think that the nurses and doctors will spend a lot of time in the room with them as their labor begins and progresses. This is simply not the case. These professionals have other patients in other rooms to care for. Yes, they will come in to do all the important checks and are really present at the end of labor and birth. So, perhaps the fact that I stay continuously with the Mom, assisting her and her partner as a birth team until birth is one of the best reasons to hire a doula."We use the many tools I have at my disposal..."During Labor:We use the many tools I have at my disposal and ones that the couple is familiar with, for example, using a birth ball, assisting in swaying/walking, acupressure, massage, shower or assistance in a birthing tub. I also use a special version of a birth ball called a peanut ball. This ball is an especially helpful adjunct when an epidural is used. Its use helps open the pelvis and move baby down for pushing while Mom rests. There are many positioning techniques I use to help the Mom make more room for baby to move and help her with pain relief.They're Here:At the birth, I can often get the first family photos, priceless moments that no one else can capture. I then help with breastfeeding for baby's first latch and, after couples have had a chance to be alone with their new baby, I make sure Mom has drinks and snacks before leaving.A Postpartum Visit:I visit the new family one more time a few weeks later. I make sure that everyone is settling in and congratulate the parents on their great accomplishment as well as reviewing highlights of their birth. By this time, they may be already working with a Postpartum Doula whose job begins where mine ends!Connie Machan, BA, RN, CD (CBI) is a retired teacher, nurse and certified birth doula. She is the owner Doula Nana (www.doulanana.com) and serves families in the Greater Cleveland Area. Nurtured Foundation Postpartum Doula Services proudly refers to Doula Nana for birth doula services!