What Does Doula Care Look Like? Part Two: Doula Support in Labor

Also be sure to read part one of my doula care series (What Does Doula Care Look Like? Part One: Prenatal Workshops)!

The all-time most popular doula question: what does a doula do during labor?

This question can take many forms, and has many shades of variation and nuance, including (but not limited to):

Will a doula replace my partner/mother/family/friends/other support people? Will a doula make my other support person(s) feel excluded or unnecessary? 

Why do I need a doula if I have a nurse at the hospital?

What does it mean that a doula will advocate for me in the labor room?

These are great questions. And they all come back to, What does a doula do during labor?

So, let’s get into it!

As your doula, I will be on-call for you typically from 37-42 weeks gestation. This means that I have my cell phone with me at all times, even at 2am, ringer turned up. I ask my clients to send me a text or call me when they think they are in early labor, and to keep me updated as questions or concerns arise, or as labor progresses.

I will come to you to support you in your labor when you feel you need me. I recommend taking early labor as a time with your family or romantic partner to celebrate and revel in the family you are right now. Many things will change with the arrival of your new little one, and in this rite of passage that is birth, it can be so valuable to your relationships and to you personally to honor the person you are before birth and the family you are before birth.

That said, if you want to take some “you” time – go for it! Many mammals crave solitude in safe, dark, familiar spaces in their labors. Plus, alone time might not be something you get a lot of right after baby is born, so enjoying this early labor time alone can be really refreshing and restorative.

When you feel you need additional support, I come to you. As a doula, I can offer labor support either at your home, or I can meet you in the hospital. Many healthcare organizations and hospitals recommend laboring at home until you are in active labor (defined as starting at 6 centimeters of cervical dilation) (https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth). This means that you will probably have some challenging labor contractions before it’s time to go to the hospital and may appreciate having doula support while still laboring at home.

When I arrive to support a client in labor, I try to get a sense of how you as the birthing person and your support people have been coping successfully thus far. I want to observe what works for you and the comfort level of the people around you before I dive in. This approach allows me to complement your instinctive coping strategies and to assist your support people in being more involved, rather than directing your labor or your family and friends.

After I get a sense of how you are coping and the comfort level of your partner, family, etc., I might suggest some position changes that I feel you might find helpful, as well as ways for your support team to be involved in a way that works for them. There are many tasks to go around in labor, from holding hands and breathing/vocalizing with the birthing person (usually a great job for a partner or other close support person) to applying counter pressure to the client’s lower back or squeezing their hips (the magical “double hip squeeze”). Some clients might really enjoy massage or acupressure on various parts of their body, both as a comfort measure as well as the physical reminder of the support people they have chosen to accompany them through the birth process. Additionally, the importance of making sure the birthing person receives adequate hydration and nutrition throughout the labor cannot be understated. Someone needs to be there with a water bottle and snacks!

These are all ways of providing labor support both at home and in the hospital. As a doula, I have a lot of comfort measures in my mental “toolbox”, so that a birthing person can continue to try new ways of coping with the intensity of labor. Even for clients planning to make use of pharmacological pain relief, they will likely experience some active labor before it is advisable to use options like an epidural and may appreciate the usefulness of these other labor coping tools.

Since there are so many ways in which a birthing person’s support people can help during birth, there are more than enough “jobs” to go around without anyone feeling superfluous or unnecessary. As a doula, I know that at the end of the birth, I am not the one going home with your. The partner, family, and friends that you have chosen for support during birth will, however, continue to be a part of your life. Knowing this, it’s important for me as the doula, to make these support people feel more included, not less so. It’s my goal to make them feel more empowered in supporting the birthing person, rather than more uncertain or tentative.

A doula also has a function of normalizing the intensity of labor, as well as a birthing person’s reactions to that intensity. I often compare myself to a flight attendant during a turbulent flight. Just as a flight attendant’s calm demeanor during a rough flight acts as reassurance that the passengers are safe, partners or support people can benefit from the calming presence of a doula who is familiar with and has supported others through the birthing process.

Those choosing to birth in a hospital may expect that this role will be filled by a labor nurse. What many people don’t realize, is the extent of a nurse’s other duties in labor. Nurses are incredible individuals, and they have a lot of knowledge, wisdom, and expertise. During labor, they are engaged in many tasks to monitor both the birthing person’s health and the health of the baby. They are communicating with your doctor or midwife to let them know how you and baby are doing. They are charting all of your and baby’s vital signs so everything is documented. They help the other medical personnel prepare for various interventions if needed or requested. Nurses love to provide physical and emotional support in labor, but that is only one of many tasks which they need to perform. As mentioned in an article by Rebecca Dekker, PhD, RN, APRN of Evidence Based Birth, “In one research study that took place in the U.S., nurses spent about 31% of a person’s labor in the room with them. (Barnett et al. 2008)”

I like to view wisdom and expertise in the labor room as a non-zero-sum game. A nurse’s expertise doesn’t make having a doula less helpful, and vice versa. I learn all the time from working with nurses, and I hope they can say the same for me. We all have valuable contributions to supporting birthing persons and their families in labor.

After you have asked me to join you in labor, I will remain with you through the duration of your labor and birth, until an hour or so after you have your baby. I want to make sure that you are stable, settled in, and that breastfeeding has been well established. Once cell phones come out and you start calling all the relatives, I usually give one last round of hugs and congratulations and I make my exit. I then meet with clients again about 5-7 days after birth. We’ll talk more about that in the next blog post.

In addition to physically and emotionally supporting the birthing person and their partner, family, and friends during labor (whether at home or in the hospital), a doula serves another vital function: communications liaison.

It is my personal experience that most nurses, doctors, certified nursing assistants (CNAs), and midwives want their patients/clients to feel well informed of the various ways they provide care during labor. I will also say that individual nurses, doctors, CNAs, and midwives have various degrees of proficiency in communicating the details, reasons, benefits, risks, alternatives, etc. of procedures to people outside of the medical profession. In other words: if a medical professional is immersed in a medical environment as their primary source of employment, they may struggle to communicate medical information clearly to the birthing person and support team.

Additionally, doctors, nurses, CNAs, and midwives work with many different people with many different backgrounds and many different goals, values, perspectives, etc. So, especially depending on the amount of time they have spent with a particular patient or client, while they may have excellent communication skills in general, they may have difficulty clearly imparting information in a way that will work for you specifically.

As a doula, while I can provide evidence-based information on various labor and birth issues, I am not a medical care provider, and cannot tell you (the client) how research evidence (which is about populations of people) may apply to you specifically. That is what medical professionals are for. What I can and will do, however, is to dialogue with you to ascertain whether you feel you are fully informed when you converse with your care providers during your labor and birth.

As part of a conversation between you and medical personnel, I may seek to clarify or open up a conversation by any of the following:

I may ask you general questions like, What questions do you have for So and So?

I may make observations such as, Client’s Name, it seems to me you might have some concerns about x,y, and z. Tell us more about that.

I may ask questions for my own education like, Dr. Last Name, can you remind me, what are the benefits and risks of this procedure?

And if the conversation ends and you still feel uncomfortable or unclear about anything, we can talk about it and give you tools to get more information from your providers. You are the person giving birth. It is your legal right to know about every procedure that is proposed by your medical team and it is your legal right to either accept or decline said procedure(s). It is of highest priority to me to support you in your legal rights.

I will try my very best to facilitate clear and respectful communication when needed. I will check in with you to make sure your informational needs are met, and to strategize with you when they are not.

It is not my goal to engage in an adversarial role with your medical staff. I am not here as a guarantee against certain birth outcomes or as a guardian against a care provider whom you distrust. Birth is so inherently unpredictable, I cannot stress enough the vital importance of finding a care provider whom you can trust to recommend healthcare that is respectful and consistent with your goals and values. This doesn’t mean your birth will necessarily turn out exactly like you hope OR that you have to do everything your care provider suggests. It does mean making an effort to put yourself in a position in which you will hopefully not have to guess whether or not a given procedure suggested by your care provider is medically indicated or not.

Many people will trust a given provider for an uncomplicated vaginal birth in which the care provider just catches the baby. What clients need to ask themselves is, Do I trust this care provider in the event that a medical intervention may be advisable? In the event that an ambiguous situation arises, where it is unclear what the best decision is, do I trust that this care provider will make recommendations that respect my goals and values?

In the end, regardless of which medical personnel are present for your birth, it is my experience that many care providers entered into their professions at some point because of a desire to help people. Many clients worry that by asking for what they need, they will be perceived as contradicting a medical professional’s expertise, creating conflict, or “being needy”. Asking for what you need is not any of those things. Asking for what you need to feel supported and confident in decisions about your health or the health of your baby helps your care providers help you.

As a doula, I will advocate to amplify your voice and support you in asking for what you need. I will work to facilitate teamwork and camaraderie between all the members of your birth team, both medical professionals and your family and friends. I will try to foster an environment of professionalism, respect, and compassion in your birthing room. That is the form of advocacy I bring to my work.

A person can compare preparing for birth like preparing to go on a long trip – only, you don’t know where you are going. You could be headed to Bermuda, or you could be headed to Antarctica. Let’s be real – it would be awesome to go to Bermuda, and it would also be awesome to go to Antarctica! But, it would probably be less awesome if you showed up in Antarctica with a suitcase full of swim suits.

Hiring a doula for your labor and birth is like hiring an experienced travel guide. No matter where your birth takes you, I will be with you every step of the way. I will give you ideas of how to cope with the physical discomfort of the journey. I will help translate when you don’t know the language. I will help you process when a change occurs in your travel itinerary. I will be there as a sounding board when you want to make a change. I want you to know that you’re not going through this journey alone. I want you to know that you are strong even when you think you are weak.

Most of all, I want to support you in what will surely be a life-changing experience for you and your partner, family, or friends.

Join me next time as I explore how a doula can help you after the baby arrives!

 

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