Can’t my friend be my doula? If your friend is a trained doula, absolutely!

In the second post in my series on what a doula does and why they’re so beneficial, I’m covering the difference between a friend or family member offering emotional and physical support in labor and a trained doula.

Sometimes families want the support of a doula and well meaning friends or family members offer to act as a doula. Even though moms love and cherish these people, usually for their second birth they end up hiring a trained doula! Here’s why.

The Cochrane research review made note that labor support is most beneficial when provided by a person trained as a doula, not just an attentive and supportive friend or family member (although they are great to have too!).

Your friends and family love you and are invested in you and in this baby. Usually they aren’t so much invested in labor or your birth plan. As a doula my job is just to help you reach your goals, and I’m in no hurry to meet your baby like friends or family may be.
In labor women may moan, cry, curse, get naked, puke, gush water (amniotic fluid), and a host of other body fluids and reactions. To a friend or family member, this would be cause for concern! And they may not let you live it down. To a doula, all these things are normal and welcome sights, and we are professionals who respect your privacy.

If you call your friend/fam support person in labor, they may or may not be able to leave work, arrange childcare, or even wake up in the middle of the night! Your doula is on call and has everything lined up to support you when you need it, even if it’s 4am.
If your friends or family see you in pain, they want to help or take away the pain, even if they don’t know how, and because they love you they’ll worry about you! For mom this can cause a snowball cycle of tension. Your doula does the opposite. If she sees you in pain she knows what comfort measures will help, she knows how to encourage the sounds and movements that will be comforting and offer progress. Unlike a friend or family member as a support person, with your doula you don’t have to worry about any baggage- she brings none (well, metaphorical baggage. I do bring a small doula bag of tools and personal necessities) 😉

What if baby is positioned funny? Not descending as expected? What if your provider mentions your baby is posterior and -1 station, will your friend/fam know what to do to offer comfort and facilitate progress? Doulas do! What if your provider wants you to consider an augmenting agent like pitocin, Foley, or AROM? Does your labor support know what those things are? Doulas do, and can give you information, listen to your concerns, and help you know what questions to ask your provider. A friend or family member may say “I think you should do it,” or “I don’t think you should do it.” Doulas won’t do that; they won’t offer or undermine medical advice, they support any decision you make.

All that said- I do really love supportive friends and family! I love to work alongside families. Women benefit the most from trained labor support, and friends and family make amazing assets alongside a doula. They can be incredible emotional support- they know you and your doula knows labor! I’ve seen them whisper the perfect encouraging words, help keep mom and dad hydrated and fed, wipe sweat from mom’s brow, and I’ve witnessed families work as a team along with a trained doula.
Let your friends and family do what friends and family do, and let your doula do what a doula does!

Next week- what about your nurse? Won’t they do all these things? Or if I have a midwife, why would I need a doula?

Do you plan to have a friend or family member present for labor support? Why or why not?

Recently a first time mom came to me and said “My midwife said I need a doula. So I think I need you. But don’t take this the wrong way, I don’t even really know what you do!” We laughed, I told her no offense was taken, and I let her know how I can help, what a doula does, and why it’s beneficial. This is a common reaction, expectant families have heard hiring a doula is helpful, but they’re not totally sure what they do.

I totally understand the confusion. I’m happy to explain! In another post I’ll go more into the studies and evidence on their benefits, but today I just want to tackle what it is exactly a doula does. There’s much info online about how the term doula comes from Greek for slave or servant, and how this applies to expectant families, but I kind of feel that’s all a bit outdated. I’m not so much a servant as more of a pregnancy and birth concierge, a helpful guide, or a supportive team member for your birth. It’s kind of a lot to cover, because if it’s just a support person can’t your friend or family member do it? Won’t your nurse or midwife fill that role? I’ve created a series that will answer all these questions, and today we’re going to cover “what does a doula do?”

What does a modern doula do?
As a doula in this day and age, I offer support and resources to my clients to assist them in planning and achieving their best birth. There are three stages that I’m able to be helpful to you, all included in my birth doula packages.

Pregnancy

During pregnancy I listen to concerns, answer questions, and support families as they plan for their baby and birth, however that may look. I have referrals for resources you may need in pregnancy- from OBs to midwives to birth classes to chiropractors and photographers- all people I’ve worked with and trust. I visit you in your home to go over early labor coping strategies and I help you think through what your goals are and assist in building your birth plan. We talk relaxation, concerns, and plans. I offer guidance and reassurance, without any agenda but to support you and your goals. I help you feel prepared for baby’s birth day.
Additionally, I offer cloth diaper classes, Babywearing 101, and birth classes.

photo courtesy Birth Boot Camp

Birth
On the big day, I join you in labor when you feel you need the support, usually in active labor. It varies from family to family and birth to birth, and you may only need the presence and quiet encouragement of your doula, or we may use several tricks and tools, but these are some of the things I may do- use a rebozo or positioning techniques to encourage baby’s optimal position for birth, encouragement and emotional support, utilize non medical means to facilitate labor progress, use birth balls and peanut balls, encourage and show partner how to be involved in whatever way you’d like, if desired use your essential oils in labor to curb nausea or discomfort, keep you and partner hydrated, help create an ideal space where you can be comfortable and labor in, as well as what most people look forward to- the physical comfort of touch, massage, hip squeezes, and counter pressure. I never take the role of or interfere with your care provider, rather I’m an asset to be used as a part of the team supporting you in birth. I never take the place of your partner, we work together on this team to support you. Doula support is beneficial for everyone, whether it’s a water birth, cesarean birth, induction, epidural, etc. No two births are the same, and most of the time physical and emotional comfort measures are all that’s needed, but studies show having a trained support person for your labor helps moms need fewer interventions and feel more satisfied. My goal is to help you reach your goals, and make sure you feel supported the whole way.

photo courtesy Kourtnie Elizabeth Documentary

Postpartum
In the immediate postpartum I help with a smooth transition for mom and baby. I have specialized lactation training and if you plan to breastfeed I’m able to help with that first latch and comfortable positioning, or if needed I can help with pumping and bottle feeding. Sometimes the immediate postpartum support a doula offers is overlooked, but it’s so beneficial for moms and babies. In the case of a cesarean birth I talk to parents about what to expect, comfort after surgery, and how to balance a new baby with recovery. I encourage mom and dad to have skin to skin time and bonding with baby, but mostly step back and allow parents to soak in their new baby. I help you understand what comes next and then leave you to relax, rest, and bond with your new baby. I’m still available to answer questions or listen to concerns in the postpartum period, whether it’s about baby, breastfeeding, or adjustment to postpartum life. Once you’re home and settled, I come visit you at home within the first 6 weeks. Most visitors are oohing and aahing over baby (and of course I can’t help but ooh and aah at the cute babies too!), but I come to listen to you, let your process your birth, see how you’re doing, and if you’re overwhelmed or struggling I can refer you to resources should you need additional support. The postpartum period is such a sacred and vulnerable time, my clients know they still have my support. I also offer belly binding to encourage physical healing and recovery, and postpartum doula services should you want more in depth help and support.
That’s a lot, right? This is a long blog post, because it truly is a lot that a modern doula does! They walk alongside the expectant family from pregnancy to postpartum and support them the whole way through. Now that I’ve said all of that, what I offer can all generally be summed up in professional and compassionate physical and emotional support and resources. That’s the short version!
The next posts in this series will talk about how a doula is different from an untrained labor support person like a friend or family member, and then how a doula’s support is different from the support of a nurse, midwife, or OB. Then finally a post detailing the evidence for doulas for all the study and statistic nerds like me! I hope you’ll check those out too!

Was there anything on this list that surprised you? Before you read this, what did you think a doula was?

-Dallas – Fort Worth – Doula – Natural Birth – VBAC – Cesarean – Epidural – Water Birth – Birth Center – Hospital Birth – Postpartum Doula – Belly Binding – Cloth Diaper Classes – Birth Classes – DFW Doula –

Tarrant County Birth Network hosts meetings in Fort Worth every month with topics that entice doulas, birth professionals, providers, and consumers alike. This month the topic was Changing Hospital Birth: An Evidence Based Approach, and I was beyond excited to hear Carla Morrow, DNP, CNM and Steven Suba, MD speak on this topic!

The two (in addition to the rest of the CNM team) make up Grace Midwifery & OBGYN, and Carla Morrow has been on the forefront of advancing evidence based and family centered practices in our area for years now, starting with Texas Health Cleburne and now expanding to Texas Health Harris Southwest in Fort Worth.

Carla Morrow, DNP, CNM & Steven Suba, MD   photo courtesy Bonnie Bee Photography

Side note: I’m also SO excited that Grace will be opening an office in Willow Park! I’ve had clients from and attended births in Weatherford (it’s my home town!), and it’s my goal to help meet opportunities that will make Parker County a better place to have a baby. Weatherford parents having the option to attend their prenatals close to home in Willow Park and then deliver in a birth center or hospital in Fort Worth will be amazing for Parker County parents!

Back to the meeting! I’ve had the honor of attending a client’s birth with Carla at the Fort Worth Birthing and Wellness Center, and she is an incredible midwife as well as visionary in advancing family centered maternity care. I loved hearing her perspective on how each of us can effect change.

Here are some highlights!

Carla started by sharing some of the statistics of Texas Health Cleburne both before and after her tenure there. Previously the hospital had a nursery separate from the labor & delivery unit and mostly scheduled inductions and cesareans. The Grace midwifery team took the unmedicated birth rate from 17% to 52%, and episiotomy rate from 16% to 4%.

If those number don’t convince you of the change that’s possible, I don’t know what will!

But why are things the way they are in some hospitals? If evidence shows that midwifery is associated with better outcomes, that episiotomy has very few benefits and shouldn’t be routine, or that newborn rooming in benefits baby and mom and should be encouraged, then why are these things not happening across the board?

Carla shared a “study about studies” that shows around 17 years pass between research being found and it’s practice implemented in healthcare settings. Plus, obstetrics is a field steeped in tradition. The American Society of Anesthesiologists now recommends freedom to eat and drink in labor so that women can keep their energy up, yet at many hospitals in the Dallas Fort Worth area moms will still be limited to only ice chips in labor. Why does the care environment not echo the evidence?

The traditions stick around, and it takes change agents to see challenges and meet them head on. So what does her model of change encourage?

• Midwifery model of care; low tech, high touch
• Promote physiological birth; labor starts and progresses on it’s own
• Collaborative care
• Respect the birth plan and birth team (they LOVE doulas!)
• Certified Nurse Midwives drive change at provider and administrative level, education for staff
• Family centered care

*(when appropriate & in the absence of health indications risk that rule out these options)

So how can we affect change? Carla mused that relationships are the key to driving change

• Necessary first step is to build trust by learning the environment, listening, and building relationships
• Identify issue; what could be better? How can we get there?
• Establish the team
• Implement change
• Monitor accountability

When she took questions, I asked how to handle the so called “hostile environment” where it seems tradition itself carries a defensiveness to change. Carla and the UNT midwife team in attendance talked on this and answered my question, how it is important to be a team player, and how we enact change by asking questions, listening and engaging with those able to push things forward, and how as consumers even just by spending our healthcare dollars with providers and at facilities that respect women and respect birth we send a message.

Carla wrapped up with talk about where we’re headed next- goals for water birth, hydrotherapy, and nitrous oxide to be more widely available, as well as in her own practices promoting early discharge, bedside resuscitation (when appropriate), and to do away with hatting! (The practice of wiping away vernix and putting a hat on babies, which studies show may hinder bonding and has no clear benefits)

photo courtesy FWBC Facebook

The Grace Midwifery & OBGYN team is an incredible care option I highly recommend to my clients, their website is linked here and they’re on Facebook too. I love working with them! Contact me if I can help!

I left the meeting feeling inspired and charged up to be a change agent in our community. How will you enact change? What do you think needs to change about hospital birth?

Sydney Williamson, certified Birth Boot Camp DOULA

– Childbirth Education – Birth Class – Cloth Diaper Class – Babywearing Instruction – Birth Doula – Postpartum Doula – Weatherford – Fort Worth – Arlington – Mansfield –