In short, a doula is someone who supports a woman throughout her pregnancy, her entire labor, and the postpartum period. She is not a medical professional but instead she is trained to inform a woman on her choices surrounding birth and helps to turn those preferences into a reality. Typically, when a woman hires a doula, their journey together starts a couple months before the baby’s due date although doulas can be hired at any point throughout the pregnancy.
Before The Birth
Before the birth, a pregnant woman will meet with her doula a couple times to discuss her birth plan. This may include things like where she chooses to birth, how long she wishes to labor at home, how she plans to manage the pain, as well as her hopes for the immediate postpartum period. A doula does not make decisions for a woman but instead informs her of the risks and benefits of her options and then supports her in whatever she decides. Furthermore, the doula will teach the woman and her birth partner (her husband, boyfriend, mom etc) different techniques that they can use throughout the labor to manage pain and keep progressing. After these meetings, both the mother and the doula should have a pretty good idea of how they plan to manage labor.
Usually, the main reason a woman hires a doula is to have a trained professional with her throughout her entire labor. A doula cannot perform cervical checks, take vitals, monitor the baby, or replace the care provider in anyway. She cannot and will not make any medical decisions. However, unlike the care provider who is in and out of the room and may leave when his or her shift is over, the doula is by the mother’s side focusing only on her from the beginning until the end. This consistent presence alone can have a major impact on the labor. A soon-to-be mom may let her doula know that contractions have started and the two can decide together when to notify the care provider. The doula may come to the woman’s home in early labor to help her work through contractions if she wishes. Upon arriving at the birth center/hospital, the doula may take time to set up the room with music, dim lighting, aromatherapy, or whatever the mom chooses. As labor intensifies, the doula will do whatever she needs to do to make the mom more comfortable, including massage, applying heating pads, giving food or water, etc. She will coach the woman through contractions, helping her breathe and find her rhythm. She can suggest different positions to help the baby continue to descend correctly and to encourage dilation. If any unexpected circumstances arise, the doula can inform the woman of her choices and help her ask questions so she can make the best decision for her and her baby. The doula does not speak to the care provider on her client’s behalf but she does encourage her and her partner to speak up for themselves and can remind the mother of her birth plan and preferences to help her achieve her goals. Finally, when it comes time to push, the doula may help coach the mom in bringing her baby into the world.
It’s important to note that a doula does not replace the mom’s husband, mother or whoever she wishes to have with her. Instead, the doula actually helps all members of the support team know how to comfort and assist the laboring woman. As a result, loved ones may actually end up feeling more at ease, relaxed, and empowered with a doula present.
Though a doula can never guarantee better birth outcomes studies have shown that when a doula is present there is a lower rate of interventions, epidurals and c-sections and labor tends to be shorter. A review of these studies can be found in The Doula Book by Marshall Klaus, John Kennel, and Phyllis Klaus. However, a doula is still a valuable asset even if the woman wishes to have a medicated birth or is planning a c-section. In these situations a doula can still help a woman through early labor, she can set up her birthing environment, talk her through pushing, and protect her wishes for the postpartum period discussed in the next section.
Immediately After The Birth
After the baby is born, the doula may remind the mother and the caregiver of any of the mom’s wishes for the postpartum period. This may include things like delayed cord clamping, immediate skin to skin, or weighing and measuring the baby beside mom’s bed. She can help establish breastfeeding and gives the mom plenty of encouragement. The doula may get some food for the new parents and she may help clean up the room. Finally, she may protect the mother’s desire for a quiet, private time with her new little family and will leave shortly after.
A Few Days Later
Within the first week or so of baby’s life the doula will visit the new mother for the last time. This generally takes place in the mother’s home and may last a couple hours. At this meeting, the doula will answer any breastfeeding questions and will encourage the nursing mother. She may do light housework for the mom or she may hold the baby while the mother gets some rest or takes a relaxing bath. To conclude their time together, they will debrief about the birth and the doula will help the mom process her feelings about it. The doula may remind the mom of important events that happened throughout the labor in order to write a positive birth story that the mother can enjoy reflecting on. After this, a birth doula’s job is complete.