The Tenants of Doula Care
The weirdest thing about being a birth doula is having to try and explain your job to those who do not know what a doula is. When working as a doula, I often think my job encompasses so much! I feel like I do everything, filling in any cracks of my client’s needs left by the maternal health care system; but then, when I have to try to explain what I do to others, my explanations often sound like I actually don’t do anything at all as it doesn’t fit into most people’s perception of birth.
The conversations usually go like this…
Me: “I help families navigate their pregnancy and birth experiences.”
Them: “Oh so like a midwife.”
Me: “No, I don’t provide medical care. I provide emotional and physical support and advocacy.”
Them: “Ummm, okay. So, you help women who are giving birth at home?”
Me: “Sometimes, but not typically. Lots of my clients actually give birth in the hospital or even use epidurals for pain management.”
Them: “So you work for the doctor?”
Me: “No, I’m privately hired.”
…
I don’t typically find it appropriate in these conversations to dive into all the shortcomings in the maternal health care system — lack of education and support, short appointment times pushed for by insurance agencies, and the lack of community support around birth (aided by its movement into the hospital system in the early 1900s). Nor do I jump into all the ways research supports doula care as one of the greatest ways to improve maternal and fetal outcomes in the United States. So, for those unfamiliar with doula support, it can feel both all-encompassing to me and lackluster to explain to them.
For those here wondering, so what does a doula do? Or wanting a way to explain our role to someone else who has asked about doula care… let’s dive into the four tenants of doula care included in our doula services.
Physical Support
Often times, people envision the physical support of a doula as hip squeezes and back massages; and while we do that (and do it well), it encompasses so much more. We help you navigate the space around you to move around the monitors, blood pressure cuffs, and IVs to make sure you are relaxed and comfortable in the space. We set up the room to feel more like home, aiding in your body’s relaxation and helping labor progress. The doulas on my team and I are highly trained in fetal positioning, or the rotation of baby through the pelvis. We suggest and move you into positions that aid in your comfort, or aid in baby’s rotation, preventing or resolving labor stalls without medical intervention.
While utilizing physical support, we work with your partner and your medical team. Doulas help your partner know what to do and how to support you. We utilize them for support in various birth positions or set them up to hold your hand or rub your back to keep your relaxed and breathing. We keep open communication with your medical team, respecting their needs for different interventions but coming up with solutions on how to work around them to prioritize your comfort and care. We grab you and your partner food and water during a long birth, let your partner take a quick nap if needed, and do any other care tasks needed by you or your support system.
Emotional Support
Other than your partner or other chosen labor support people, most of the people at your birth will be strangers on the day of delivery (if you’re giving birth at the hospital). You may have your regular doctor or midwife there, but they typically only pop in for a few moments during the birth; and there is a high chance a different doctor or midwife you may have never met or only briefly met is the one on call on the day of birth.
Your doula is someone you interview and choose well before your birth day. We build a bond throughout pregnancy, both through prenatal meetings and classes and through texting and other communication during your pregnancy. Your doula is someone you hand pick who is part of your support team and guaranteed to be there to support you on the day of your delivery — and who will likely stay the whole birth as we don’t work in shifts like medical care providers. This aids in a unique emotional support component that is hard for someone like a labor and delivery nurse to replicate.
We will be there to be your shoulder to lean on when things get hard, your listening ear, and your answerer of all the weird questions you feel embarrassed to ask your doctor. As a doula, I often find that my clients, and especially their partners, are often confused about different things in their care plan that their doctor told them. I am there to help decode the medical messaging and bring down the confusion or anxiety and support you alongside your medical team. We can talk through what is happening, slow things down if you are overwhelmed, and help you know what questions to ask your doctor or midwife during your appointment times so you can feel supported and prepared inside of the system.
Advocacy
Advocacy is a controversial tenant in doula care. Some doulas do not believe advocacy fits inside the role of a doula, but I vehemently disagree. Many doulas confuse advocacy with creating dissension in the birth space between them, their client, and the medical staff; or they believe advocacy is talking for their client. Neither of these things are true.
The role of advocacy in the birth space is to help make your client’s needs well-known and figure out a path towards having them fulfilled. As a doula, I have purposely sought out and become trained in non-confrontational advocacy techniques, and I constantly seek ways to bring the birth team together, not pit them against each other.
Advocacy to me is asking questions, creating space for conversation, and helping mediate between the medical staff and my client when their goals differ. Advocacy in doula work includes helping your client find community resources for needs that fit within their desired goals and budget. As a doula, we are on our client’s team, and our job is to move the mountains that need to be moved to help them feel supported, safe, and respected during the perinatal period.
Childbirth Education
Doulas do not provide medical advice, but we do provide general information on childbirth. For example, we can explain to you the different medical and non-medical pain management options, but we wouldn’t tell you if you are or are not a good candidate for an epidural. We can tell you the different stages of labor and signs you are in different stages but wouldn’t check your dilation. We can tell you the different medications typically used in the process of an induction, but we wouldn’t tell you which ones you should include in your induction plan.
Doulas are a great source of information and knowledge smack dab between google and your doctor. Have a question about how to prepare your body for labor? Ask your doula! Wondering if your blood pressure is concerning? Ask your doctor!
There is so much advice and information needed during the perinatal period that isn’t directly tied to your medical care, because birth is not only a medical event! A good doula knows when they can answer your question and when to tell you to call your doctor.
We are great resource for all the various questions about pregnancy, birth, and postpartum (think breastfeeding and newborn care questions); and using us will keep you from doom scrolling or finding very scary (and often irrelevant) articles on google.
If you are pregnant and curious about how doula care can support you and your partner through your birth, check out our birth packages and schedule a free initial consultation with your doula of choice! We love educating about doula care and explaining our role in the birth space — as we believe every birth deserves support.
