There are many roles in life that are misunderstood until you either are in that role, or need the help of that role. How many of us were fully prepared for parenting or knew what it really involved, before we became parents? And how many of us complained about our parents when we were children, only to grow up and realize what a difficult and misunderstood job it was? One of the roles that can be very easily misunderstood is that of doula. I and other doulas often hear some interesting comments and some of them can show how little others often understand about what we do as doulas.
I have sometimes heard people say, I wouldn’t want a doula because I wouldn’t want someone talking to me during my labor, or I wouldn’t want someone telling me what to do during my birth. Sometimes I hear that doulas are bossy or controlling, or my friend had a doula at her birth and she did nothing. Some people think a doula would make them feel guilty if they wanted an epidural and even that doulas force people to breastfeed and eat their placenta or make them refuse medication.
When I and other doulas hear these comments, they can be brushed off as uninformed. But they can also be hurtful, because none of these comments hold true to what we do in our role as a doula! The fundamental job of a doula is to help a client in whatever capacity they might choose. We are not there to tell anyone what to do, but what the client wants might vary considerably from one person to the next and that can look confusing from the outside looking in.
I might be very hands on at a birth, being close to the client and breathing with her while her partner rubs her back. I might be rubbing her back while the partner keeps eye contact. Or I might be sitting on the other side of the room looking like I am doing nothing, but I’m actually providing support just as that client wants by just being there.
I might be in a client’s home late at night sitting in silence, or outside the house sleeping in my car because she wants to know I am close by, but doesn’t want my physical presence yet. A client might request that some family members not be allowed into the labor room, and the doula is the person that gets to deliver that request. Or alternatively, I could be sitting with a client and her family and friends talking and laughing while the client is nearby listening and laboring. That same client might do this for hours very happily and then call me over and ask me to sit closer and whisper at the start of a contraction, “…make the talking stop”. Making a hand motion to quiet the family or friends is sometimes not well received, but it’s not about how people perceive me. It’s about what that client needs and wants, which is why I’m there in the first place! And vocalizing the request would bother that client just as much. Upsetting family members might be necessary in serving that client. Doulas do what needs to be done because we are there to serve our client, however that might look.
Some clients breastfeed, some want to encapsulate or eat the placenta, some don’t even want to see the placenta. Some want pain medication, some want doulas to remind them of non-medical options, and some want us to immediately call anesthesia. We support all of that, because it is all up to them.
A nurse might walk into a hospital room and see the doula quietly sitting across the room away from the client and leave the room thinking, that doula is not doing her job. Though the doula doesn’t appear to be doing anything, she is alert and carefully watching and listening to her client. Or the midwife might see a doula with her face inches from a client’s face counting her breaths and think that doula is very intrusive and annoying! A doctor might walk in and hear the doula offering a client other comfort measures instead of an epidural and think the doula is keeping her from getting an epidural, when that doula is doing exactly what that client asked her to do.
What others do not see or know is the hours we spend with clients before labor starts. We discuss past birth experiences and other life experiences and what they might want and need during this labor and birth. We go over any and all choices and things that could happen and what their desires are. We discuss the partner’s needs and what other people might be present and how they see their roles. We might talk about coping techniques and laboring positions or we might not, depending on what they want.
During all this, we are getting to know each other so that by the time labor starts, the doula is very aware of what that client needs and the client is very comfortable with the doula. Doulas can read body language and react to her needs without the client having to voice them. I can tell by the look on a client’s face that it makes her tense when a nurse walks in the room and starts talking, so I hold my hand up to indicate wait a moment. Sometimes I have to wave my hand in the air to get their attention. What I don’t do is say please stop talking because that is doing the very same thing that is already causing the client tension – talking!
Sometimes during a contraction I will see the client bring her hand around to her lower back so I might suggest her partner apply some counterpressure. Then I watch how she reacts to see what adjustments we can make without having to ask questions. I also check in with the partner to see how they are doing and provide reassurance and promptings if needed.
What I don’t do is ask the laboring person a lot of questions because when active labor and transition hit, it is better for them to not need to make decisions. Then they can be in that out of worldly place where feelings are what is important and not force them to be in the thinking part of their brain! Having a doula present allows them to let go and follow where labor takes them because they know their doula will watch over their partner and support people and themselves. We can help a partner answer questions from medical staff because we have discussed all the possible events and decisions and know what the client’s wants and needs are.
When labor goes in unwanted ways, which it sometimes does, the doula is there to remind them of their options both medically and emotionally and help them ask the medical staff questions. We might remind them of medical pain control options, and not to discount them. We never belittle or discourage them. We might suggest non-medical options because that was their preference, but not because we get special rewards for having clients who don’t choose epidurals or narcotics. Sometimes a client’s desire was to receive an epidural at a certain point in labor, so our role might be to remind them when we see that time coming. Once the epidural is administered, we continue to do the same job of support that we were doing before.
Our biggest role as doulas is always to protect the bubble the client is in; to protect their space. To be there to answer questions and provide information and support as decisions are made. We remind the birthing person that they are in charge and it is their body and their baby and their birth! It is never the doula’s birth or the doula’s decisions; the job is to support the client as they figure their way through their very unique labor and birth.