What to Expect
It took several years for you to decide to become a doula.
What is your story behind the decision?
When we were pregnant with our first, I took Bradley Method classes and enjoyed them. We felt prepared, and my husband worked wonderfully to help me through each contraction. But my water broke at 7:00 a.m., and we were told to be at the hospital by 8:00 a.m. (and we were). Labor wasn’t incredibly intense by then, but we did as we were told. I was able to walk for hours around the L&D floor, and we felt confident in our OB’s presence. But then she went off-duty at 6:00 p.m., and the on-call OB from her practice who took over care was less impressive. His first comment to me was that I’d been laboring for a while and since my water had been broken for 11 hours, it was time for a C-Section.
His reasoning, that he repeated over and over, was that the risk of infection increases the longer you go after water breaking (which is accurate, of course). But when I’d ask if there were any signs of infection, he’d say no but repeat saying that the risk increases. This wasn’t a good enough reason for a primary C-Section for me, so I spent the next five hours fighting him instead of truly focusing on laboring. I became worried and fearful of going against medical advice, but my nurse assured me that I was laboring well and baby was tolerating labor wonderfully, too. I ended up delivering vaginally just after midnight, but it was an unnecessarily frustrating experience because of the way we were treated.
I knew I wanted something different for future birth experiences, if I were blessed with more children. We ended up having a 34-hour labor for our second baby (instead of it being shorter, it was nine hours longer), but I felt secure and supported. I was sold on the fact that how secure a mother feels during labor and birth is not irrelevant; I knew then that I wanted to learn how to help other women so that they feel supported, safe, and as comforted as possible during such a vulnerable time.
Where did you receive your training & from which organization?
My training and certification are from A Sacred Journey Doula Training Program, which is an in-person course I took in 2013. It required two full days of training sessions; reading the assigned textbooks; and attending three births as a probationary doula, writing up the experiences and reviewing with my trainer, who is a Certified Professional Midwife/Licensed Midwife and professional doula herself. I specifically chose this training path because many (though not all) of the national organizations that train doulas also offer training in how to be a “full spectrum” (abortion) doula, and I simply cannot reconcile that with my faith.
I looked specifically for a Christian-compatible doula training, since my desire to serve others as Mary served Elizabeth is the very reason I wished to be a doula. I also greatly desired to take an in-person training so that we could practice physical coping techniques and have any questions and concerns quickly addressed and answered. Furthermore, I have easy access to my trainer’s advice and help if at any time I feel I need to brainstorm how best to help a Mother.
What are your religious beliefs?
I am a Catholic Christian, and that's actually why I have enjoyed the four unmedicated births I've experienced—I love lifting up prayers during my contractions and meditating on Scripture verses and passages I've picked out, uniting my suffering with Christ’s suffering on the Cross for love of His Church. I make a list of prayer intentions that I pray through with each birth (and then I keep them and put them in my kids' baby books). That being said, I suffered plenty even with the epidural during my first labor; but I would have liked to felt the full weight of the birthing experience.
I've worked with many Catholic clients who share every facet of my beliefs; I've worked with other Christians who also enjoy praying and meditating during labor; and I've worked with clients who have no interest whatsoever with praying but who of course also deserve a supportive doula who works with them through contractions, fears, pain, and the joy of birth. Birth is an everyday miracle, no matter what faith a person professes.
What materials do you bring to the hospital when your client goes into labor?
My doula bag is always evolving, but normally at least these things:
Several textbooks in case I want to reference something or let a client or father look up coping techniques with illustrations/instructions so they can be more hands-on
Toiletries and essentials for myself (especially a change of clothes and shoes, toothbrush, etc.). I've been at births for a minimum of six hours and a maximum of 51, and I’ve seen my fair share of just about every bodily fluid on my clothing and/or shoes. It’s just another day in the life!
Tennis balls for counter pressure (some people prefer that to the feeling of a palm or fist)
New tubes of chapstick for moms who are dehydrated
Water and snacks for myself, and dad if he didn't bring enough (and mom, unless she is on a restricted diet)
A rebozo for tummy lifting and sifting
Essential oils (for use if requested)
How do you typically work with the Father?
That depends on what kind of birthing classes parents have taken and/or how involved dad wants to be. Some dads do really well applying counter pressure, lifting with the rebozo, etc., and I teach him how to do these and switch out when he gets tired (because it's quite tiring). Some dads are better at emotional support of their wives and prefer to hold their hands/shoulders while praying with mom or comforting her with words--and I apply counter pressure or hip squeeze or whatever is needed physically to cope. [This is a very common way the Father and I both work simultaneously to support the Mother]. Some dads, despite their best efforts, *intend* to be the primary physical labor support, but for one reason or another, mom prefers the doula's touch. I often warn dads that this can, and actually often does, happen, and not to take it personally!
Doulas are trained to use physical coping techniques, and many dads just don't have a feel for the right placement of their hands or don't apply enough pressure, or whatever the case may be. Furthermore, because the mom is so emotionally tied to the dad, sometime she will lash out at the dad just because she trusts him so much and needs a place to put her emotions. So also be warned that that might happen, too.
What is your process of getting to know your clients?
Depending on how early on in the pregnancy I am contacted, we schedule from 1-4 prenatal meetings (1-2 if I'm hired at 37+ weeks, more if earlier). Basically, I meet with the clients until we all feel confident that we know the goals of the mom, have answered the big questions looming, and feel comfortable in each other's presence.
What are some ways you help moms deliver naturally?
I think that actually the most important aspect of doula work is the calming presence, experience, and assurance that a doula (who has often given birth many times herself, and has worked dozens of other births) brings to the environment. Fears and worries really do slow down labor and of course make it less enjoyable. But the answer to this question that most people are thinking about is through the physical coping techniques I employ to help clients cope with contractions.
I help clients find a rhythm that works for them, and I help guide them through each contraction and through the waiting. Also, since I've seen many different moms and many different births, I have a large repertoire of positions and techniques to suggest to help baby get in a good position, to give mom the rest she might need, to help strengthen contractions or speed them up, etc.
Before the labor even begins, I work to ensure the family is seeking and finding the information they need to make informed decisions with their care provider. It is not within the scope of practice of a doula to make decisions for a laboring mother, but I prompt mothers and fathers to ask the questions they have expressed they want answered, and I “translate” what a provider says if my client is confused by the terminology. (For instance, if a nurse checks you and says you’re now at a +1 station and then leaves before explaining what that means …)
How do you deal with nurses and doctors that are not supportive of the Mother's birth preferences?
When you arrive, you should ask for a nurse who enjoys working with patients desiring an unmedicated birth. And keep in mind that you can plan everything to a T, but truly, it's a birth preferences list. There might need to be changes and some flexibility, but it should give the staff a very clear picture of what you are hoping for. When doctors seem resistant, you simply need to keep asking them if you are in distress or if baby is in distress. If not, then you can stick to your hopes and continue doing what you are doing.
If one of you IS in distress, obviously, it would be wise to alter your plans and follow the medical advice of the doctor. But sometimes the doctor will suggest interventions simply out of routine or because of his or her own timeline but not because the actual Mother or baby is needing the intervention. That's when you can question if one of you is in distress and feel confident in your decision to decline the intervention. A doula does NOT speak for her patient to the medical staff. I can turn to the laboring mother and her husband and say, "I remember you saying that you desired ______, and there are a number of courses of action that can help or hinder that. If you have any questions for your doctor about various options, please ask him/her now." But I can't speak to the doctor and say, "She wanted to do _____, and that seems incompatible." Mother or Father has to be the one to say that. I can only remind you of your desires to prompt you.
If you’re completely unsure, you can then always ask for a few minutes to think it over and have them leave the room. Unless it’s an emergent situation, you will have at least a few minutes to consider your options in private.
When I go into labor, what is your protocol? When do I go to the hospital? Do you come to our home first or meet at the hospital?
When a client has any questions or concerns leading up to labor, I suggest they call or text me to keep me updated. When it seems labor is actually started, I like to hear mom talking through a contraction or two on the phone to see just how the contractions sound so I can judge how early labor is. It's more art than science.
From a practical standpoint, I love when a client texts me that she MIGHT be in labor just so I can start making babysitting arrangements if needed for the day (I have five little ones myself!). But I like a phone call when things are moving into a pattern so that I can hear how the contractions sound. I can make a more educated judgment call from that than from simple timing of contractions (though having your contractions timed on a timer app is still useful information!).
Normally a doctor will suggest that the Mother leave for the hospital when contractions are in a “5-1-1” pattern: five minutes apart, one minute long, and in that pattern for one hour. But each doctor has his/her own preferences, so you'll have to ask him/her. Most doctors will tell you to come in immediately if your water breaks at home.
So where I go depends on the labor. If you are making progress (contractions are steady and increasing in intensity and frequency and duration) and want me to join at your house, I go to your house. If you hit that point and decide you'd like to go to the hospital, I meet you at the hospital. Generally, for hospital births, I tend to be called in when it is time to go to the hospital, but again, I am open to meeting at the client's home if that is preferred. Obviously for home births, I go to the home. :)