As a doula, we hear that comment frequently. “I have a friend who is going to be my doula….” And at first glance it seems like a good thing. but is it?

First let me say, a doula does not need to have been trained or credentialed in any way to call herself a doula. She can say, “I am going to mother the mother, therefore I can call myself a doula.” And this is very true. There is nothing stopping her from doing so. But those of us who have undergone training, read a ton of books, been critiqued and evaluated feel a bit sad when we hear horror stories about the doula who overstepped her bounds at a birth, knowing that with helpful training, she would not have acted or reacted this way. It also makes us sad when someone has a friend who is their doula, without any experience or training and has a false sense of security that they have the support and benefit of a doula. She has not had a doula at all. She had a friend with a huge heart and desire to help her.

If you are going to attend a birth without any training or knowledge of what the trained and certified doulas have as a code of ethics, just call yourself a birth companion. You can still make a huge difference perhaps, but the staff at the hospital will see you as just that, not a professional doula. It helps those of us who feel the need to meet the standards of certification to be seen a bit differently and held to a higher standard. You will not taint our reputations as doulas when you step outside the bounds of a credentialed doula. The truth is a mom supported by a birth companion will be better off than one alone. And I only ask that you make sure those who enter the room know you are there for the mom and do not represent doulas per se or any certifying organization. And the monitrice who is a doula plus offers some additional skills, does not cloudy the water of the doula- call yourself a monitrice when you tell the nurse how far dilated you found her to be when you felt the need to do a vaginal exam. (more…)

I met this wonderful blogger-Donna Ryan- http://banned-from-baby-showers.blogspot.com/and  had already been to her blog several times- and she offered this great blog article to be shared with you on our blog- I am sure it will offer some good advice for many of you! By the way, she is not a doula but a childbirth educator.

Some of you might remember reading about one of my couples that accidentally gave birth at home last year.    The plan was to have their doula – who was at the birth – have a doula-in-training shadow her at this upcoming hospital birth.  Frank, the father-to-be, referred to the student doula as “the dude-la” — she was to behis doula!  His “dude-la” was actually at another birth when Nancy gave birth at home, much to Frank’s dismay.  I wish I could take credit for coining this term, but I have to give credit where credit is due.  It makes me laugh every time I think of it.

I always have a couple of doulas that I refer my students to, usually for a bargain price, as my students are usually very prepared for labor and birth.  A bit less work for her — certainly less educating on her part.  I am very picky about who those doulas are.  Like lactation consultants, doulas are not all created equal.  I knew of a doula in Albuquerque that had a 90% epidural rate! Certainly not the doula I wanted for my students!

The first question I always ask is why she wants to be or why she became a doula.  I am amazed at how many women become doulas because of a personal traumatic birth experience.  They want to help other women not go through what they went through.  That is totally respectable, but not necessarily who I want at my couple’s births.  She will often be defensive and looking for things to go wrong.  Her “bad” birth experience led her down this road and she is, in my opinion, trying to right a wrong.

I have been writing about the birth team a lot lately — doulas, midwives, and OBs.  I’ve decided that it is 50% of the “requirement” to having a happy birth experience.  Education is great, an absolute must, but if you are surrounded by people who do not believe in your ability to birth your baby without medication or intervention, you likely will not be doing so, no matter how prepared you and your partner are.

If I were looking for a doula, these are things I would want to know:


Has your doula given birth?  (It is hard for someone who has not gone through labor and birth to understand the thoughts that go through a woman’s head during labor.)


Where did she give birth and why did she choose that location? (If you are planning a homebirth and you are hiring a doula who has only given birth in a hospital, you might ask her why she chose to not birth at home.  She may, deep down, be fearful of birth.  Or maybe it was an issue with insurance.  Or maybe her husband was too fearful.  Find out why she birthed where she did.)

Did she have medication or intervention?  (When the going got tough, how did she handle contractions?  What seems to be her general attitude about medications and interventions in labor?  Does she really believe that these things are usually not needed?  On the flip side, is she willing to use intervention if required?  Does she recognize that sometimes a woman may need intervention or medication?)


Has she ever been “overdue” and how did she deal with that?  (A woman will naturally doubt her body’s ability to start labor on its own towards the end of pregnancy.  Having an encouraging doula by her side, reminding her that her baby and body knows just when the time is right, is crucial.  The “overdue” woman is bombarded with questions of when she is going to finally induce, and her doula will be her rock in refusing induction.)


How long were her labors?  (There is an emotional tug-of-war here.  Most women hope for a short labor, but that is often much harder, physically, than a longer one.  A long labor is not only physically challenging, but very mentally difficult.  It’s just interesting to hear her perspective on length of labor.)

What is her c-section rate?  Epidural rate?  (Some things are obviously out of her control, but if her rates are higher than you think they should be, she may not know how to really help a laboring woman – which may be a physical or mental issue.  If she doesn’t know her rate, ask her to figure it out.  You’ll be doing her a favor, trust me.  She should know this information if she’s never figured it out.  If her rates are high, she can evaluate what she can/should do differently, and if they are low, it will help her in talking to potential clients.)


Where is her favorite place to doula?  Hospital, home, or birth center? (Listen to her answer on this one.  This tells you who is the most supportive of doulas at a birth.  It’s usually the places where she feels like she has the freedom to work with a couple and her opinions and experience is valued.  These are usually good places to birth.  If a doctor or hospital is not at the top of her list, it’s usually because they have policies and procedures in place that make it hard for her to really help you. They are usually resentful of her presence and feel that she is interfering with their work.)


Does she have backup with similar rates and philosophies?  (I don’t want certain doulas at my student’s births, so I want my doulas-of-choice to have doulas backing them up with similar styles and philosophies.  Things come up in life, and your doula could have the flu the day you start labor.  Ask about her backups.  You will all be more comfortable if you know these things in advance.)


Does she have “time limits” of being away from home (nursing baby, child care, husband’s job, etc.)?  This is one reason I don’t doula.  I have lots of kids, all attending different schools.  I don’t let them ride the bus, so I spend half my day in the car.  I don’t live near family to depend on either.   Oh yeah, and I have a husband with a demanding job.  Lastly, I don’t have the patience necessary to be good doula!  If she does have “time limits” she may be very distracted.  Know what the issues are and how she deals with them.  For example, she may need to pump breastmilk every 4 hours during your labor.  If you are fine with that, great.  If that will drive you crazy, she’s not the doula for you.)

Lastly, ask her what she literally brings to a birth? (One of “my” doulas is a massage therapist so she doesn’t bring a lot of physical items to a birth.  She brings her hands, ready to work.  She knows acupressure points that stimulate labor and actively uses them throughout labor.  Other doulas have a bag that they bring, full of “birth toys” to help throughout labor.)

It’s nice to know what your doula brings to a birth, both literally and figuratively.

I hope this list helps you in your search for a doula.  They are such an important part of the birth team.  I see more epidurals and c-sections at births without a doula than those than have a doula.  And if your husband is resistant and wants the job all to himself, start calling the doula a “dude-la” and remind him that she is there as much for him as she is for you!

A good doula is like a chameleon

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She becomes what the moms needs at the time. Yesterday I attended a tough birth. Not because it was extra long or tedious or even full of interventions- it was a natural birth of average length with a delightful couple. It was difficult because I felt like I could not use any of my doula talents or tools.  I spoke to the midwife, my friend, about it afterwards. She said, “You provided exactly what she needed.” This mom does not want to be touched in labor- that is right- no massage, no counterpressure, no stroking- no touch. And since she is very knowledgeable about the right way to breathe and vocalize, she wanted no guidance in these measures either. So I sat. I quietly supported her husband. I offered a few suggestions for his comfort.I offered words of encouragement along her journey.  I took pictures. I cleaned up the bed when she was out of it. I offered music although in the end she did not like it.  But birth is not about me. It is about her. It is about what she wants. The midwife in mid labor made a suggestion I had just recently made. The mom had declined it. The midwife said, “Sometimes they do not know what will help, what they need. So you just do it.” So we did and the mom took that suggestion for a while. Again later I leaned in and whispered some instructions to her to help her with pushing. I feared she would not like it but she accepted the suggestion and it worked well for her. But I drove home thinking about it- I was exactly what this mom needed. I did not get to play my usual role- but it is what she needed. Before I left she told me how happy she was with my service to her.

As doulas we learn early on the mantra, “It is not my birth.” But it is hard to hold back when you think you know things that may help a mom but she declines the help. But a good doula offers and then honors the mom in her desires. A good doula knows how to be what the mom needs her to be.

 

Let me first say, this is what a professional doula does not do. There are folks out there who call themselves doulas who have never had training or have trained but chosen to not certify. That is fine. It is not a requirement to be trained or certified to call yourself a doula. But please act professional. When a doula steps outside of the protocols of a professional doula, she risks the reputation of all doulas. So, this is about what I personally feel a doula should not do.

A certified doula signs a code of ethics and practices within her scope of practice. I have been a certified doula for a long time- with DONA and with CAPPA. I am currently certified with CAPPA.  Here is the scope of practice I follow- CAPPA SCOPE OF PRACTICE.

 

  1. The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.
  2. During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.
  3. During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.
  4. During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed.

So doing vaginal exams is not what a doula does. Have I, yes twice when a mom was birthing at home unexpected and I arrived to find her pushing. I called her midwife both times to let her know that yes the baby’s head was right there! I did check so I could let them mom know my opinion on whether she should get in the car or call 911. Both times the mom asked me to confirm what she was feeling- and it was a small internal finger hitting a head check!  Is that me acting as a doula….NO! It is me acting as a good samaritan person who had the most birth knowledge in the room at the time. Did it feel scary and weird- YES! But did I feel it was needed- YES! Both moms birthed within minutes safely and had a midwife there moments after the birth to provide medical assessment.

So, when a doula says she can offer a vaginal exam – then she is acting like a monitrice- not a doula. She should have learned these skills from a midwife. If she says she does this, you need to ask where she got her experience. And also you need to  think about how important is it to have a vaginal exam performed on you in a normal, non emergent situation. Rarely is a vaginal exam needed in labor at home if you are planning on going to the hospital. Trusting your care provider to send you home if you are not dilated enough, trusting them to not interfere in ways you do not desire, are imperative.

Information gathering is wonderful. Even providing information that is something they did not know is even better. But the role of the doula is not to require a mom to have the birth that the doula wants- but the one that the mom wants. Making sure she has information to make an informed decision is most important. I wear the hat of childbirth and parenting educator- so often I provide a plethora of information. When a mom tells me about the birth ideals she has and I realize the provider or the place she has chosen may not provide what she is looking for, I often tell her about other resources. But whether she chooses those options are up to her. I support what she decides once she has the information.

A doula remains with the mom or couple during the labor. I do not think a professional doula leaves a mom in labor unattended. If the labor is too long, she can certainly call in a back up, but she remains with the mom until her back up arrives. There will be times for bathroom breaks, quick meals and even a nap if the mom is walking the halls with her partner or resting herself. But she does not leave the mom unless the mom dismisses her. If a mom chooses medication, a professional doula does not decide she is no longer needed and leave just because the mom is medicated. I love what Persis Bristol says, “just because the mom’s body is numb does not mean her mind is numb!

Our company provides a postnatal meeting to review the birth and see any pictures that were taken. We love this time. Some moms drop by on the way home from the hospital to get breastfeeding assistance and the postnatal is done then. Others may wait a few weeks, some months and some just ask for me to send the pictures and notes due to hectic schedules and returning to work. But I have to say I miss seeing the new family if this is the case. I have some moms who text, email and call frequently to chat about baby and parenting concerns. We welcome this.

This week four things came up. 1. One was a potential client who asked if we required her to have to be committed to a natural birth. I discussed options, informed decisions and how this was her birth. Sometimes doulas project their own bad birth baggage onto their clients. They also feel the need to “save” their clients. And sometimes they feel compelled to force their birth dreams on others.   2. The other thing that was shared with me was how a doula had some issue with having to pick up her child and left the mom who had gotten an epidural, and then never ever returned to the mom during the labor and birth.   3. I had a strange question asked of me by a nurse.  It made me curious when a nurse asked me if I did vaginal exams on the mom prior to her arrival. I explained that I did not do vaginal exams. Then the attending midwife shared how a doula who says she is a monitrice had a mom arrive and proclaimed her to be in very active labor- 7cm dilated, only to be 2 centimeters. This was making the nurses misunderstand the role of a doula.   4.  I had a mom recently ask if she ended up with good biophysicals from her perinatologist and was like her mom and went to 43 weeks, would I still be her doula since our agreement says 42 weeks. I assured her I was her labor doula until she gave birth!

I think it is important to know all doulas don’t follow the same rules or scope of practice. All doulas don’t provide the same services.You may want to ask a lot of questions. Perhaps you should ask where she received her training. Ask if she is certified and if she is not, ask why. Ask about her scope of practice. Ask about her experience (there are doulas in my area who are just starting out and charge more than very experienced doulas in the same area). Ask away- you may find some of the answers are exactly what you are looking for, or not.

 

Picture this:  A woman in the hospital in labor.  She is lying in the bed, moaning through contractions.  An IV in her arm tethers her to a pole beside the bed.  Her contractions are irregular, often slowing to just four and hour.  She is progressing, but slowly.

If you were to share that image and information with a group of birth professionals, the reaction would be the same from most of them.  Get that woman out of bed.  Get her moving.  Let her eat.  Let her drink.  Get that IV out of her arm!

But let me share the rest of the story.  This woman has been in labor for nearly two days.  She hasn’t slept.  She is exhausted.  She has been drinking water, but has no appetite and is vomiting frequently.  Her exhaustion leads to fear, to doubt.  She doesn’t think she can do this much longer.  Rather than tell her to get up, move, get her contractions going—or worse, administer pitocin– her doula and midwife listen.  Her doula suggests resting in the bed in a position still conducive to labor.  Her midwife suggests that maybe IV fluids would hydrate and revitalize her.

Now she is the picture mentioned above.  And because she listened to her body…. because she had a midwife that knew that the baby would come when ready…because she had a doula that recognized that there is a time for rest as well as activity in labor…. that mom, the one tied to the hospital bed having four contractions an hour, gave birth to a healthy baby boy just 40 minutes later.

– Renee Wymer

Relationships take time to develop. When you pick a doula it is best to hire her as soon as you can so you can develop a relationship with her. She needs to be someone you feel you can be honest with and share your inner most thoughts regarding your birth fears and ideals. It needs to be someone you can trust. This is a double road though- it is up to you to make this happen as well as the doula.

We had a client who hired a doula several months out. Although they discussed things and chatted along the way, some things were said or shared that made her question her decision in her selection of her doula. She did not address these concerns. She did not ask for clarification or share her thoughts about what was said or misunderstood. And just like when your partner does a bunch of little things that bother you and you do not address them, the group of them together makes for a sore spot between you. This did not make for a relationship that would foster a great doula-client relationship.

We see women select care providers and find out along their journey that this care provider was not going to be supportive of their ideal birth. But instead of addressing their concerns, they either dismiss them or they decide that perhaps it won’t really make a difference. But this is a relationship that will not foster a great care provider-client relationship.

Do yourself and your doula a favor… in fact do everyone in your life a favor and share with them the thoughts that make you uncomfortable when they occur. Address them so they can either be resolved or so a decision can be made early on to switch doulas if the doula is not a good fit. Sharing early on may have been something that could have allowed the relationship to grow and flourish rather than falter. After all it is about the relationship. Every match is not one made in heaven. But being honest is the best way to maintain relationships that will bring the blessings to your life and your birth!

We had a client tell their doula they did not want a particular doula to be their back up. When questioned about it, they did not feel she would be a good fit since her personality when they met seemed different than what they felt they may need in their labor. We have enough back up options that we certainly are able to accommodate that request. But keep in mind, just as Paul states in the Bible that he became all things to all people to win as many as possible, a doula can become what you need. For instance I have had clients want me to be gregarious and fun in their labors. I have had some ask for almost complete silence in their labors. I have had some who loved the casual conversations in the background that insured them all was normal. Doulas become what you need in your labor. But you need to let them know what you need. Since every woman has her own particular needs, your doula needs to know what you think you will need. But ironically that may change when you are actually in labor. She knows how to be flexible as your needs change.

A doula who is gregarious and funny at the Meet and Mingle may be the quiet, calm spirit who holds the sacred space of labor and birth for you. So, remember just as you may have a different personality at a party than at your labor, so she may as well. Ask questions that will enlighten you to her full personality before deciding she may not be who you are looking for to support you.

I often tell women not to lie to their care provider- don’t expect them to be truthful if you are not willing to be truthful to them. I feel if you can’t be vulnerable and honest with them, your relationship is not one of trust for your labor and birth. This is certainly true for your doula as well. Be honest, be vulnerable, be open- it will help your relationship become what will be most beneficial to you for your birth experience. Understand that misunderstandings occur, but share your feelings if they do so it can be cleared up. Communication is paramount for growth in this relationship.

I spoke to a friend who is a bit older than me. I said the bad thing and the good thing about getting older is you don’t care what people think of you. But the truth is you should always care how others feel from your actions or words. But again, sharing how one makes you feel will help resolve any negative feelings you may have from someone else’s actions. She said that sometimes when we get older we know things, we feel we need to speak the truth- even bluntly- and that those who are not in the same place are unwilling to hear the truth. I think about the phrase, “folks don’t care how much you know, they need to know how much you care.”

Sometimes I think in an effort to share what we know from our experience, we have our comments come across too emphatic and opinionated. I used to think that if you did not fully believe something, then you could not really have a strong opinion worth sharing. Now with age I realize everything is not so black and white. Fully supporting women sometimes means not sharing your opinion unless they really ask for it. As a doula that is often hard to not feel the need to share what you feel is truth that will protect them. But sometimes too much information can overwhelm a mom. It is a fine line in this relationship. We begin to feel responsible for them instead of to them.

Polly Perez a friend of mine- and an internationally known birth advocate shared this with me recently. ”

I had to remind myself the difference between feeling responsible TO or FOR many times….
That is why I wrote the following handout and even put it in one of my books hoping it might be helpful to others.
Hope this will help your in some way in your current situation….

Here is the handout—
The Difference in Feeling Responsible TO and FOR

When you feel responsible TO others….
You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.

When you feel responsible FOR others….
You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.You expect the person to live up to your expectations.

So, find a care provider and a doula who will feel responsible to you. And be responsible yourself and share your feelings- after all it is about developing a relationship. Be open and honest. Let her know what you think is important and will need. And then know you will be fully supported in your labor and birth!

The person who filmed and edited this film sent me this link

Do You Doula? the video

I thought I would share it. Although I am always a bit concerned with doulas who feel the need to “save” other women due to their birth experience… I do think that can be the initiating impetus that drives some women to become doulas. So although the very first frame makes me a bit concerned- the rest of the film does share some good information regarding doulas.

I think doulas are definitely there to be a birth guide of sorts… a childbirth professional there to remind the parents of their original plans. But also as a support system to help the mom and dad know that they are strong and can do this. I think the message of this film does share those thoughts.

If you have questions about what a doula does and how she interacts with you and the staff, this may be very informative to you. I am a certified doula and I do think it is important to understand that training does set some doulas apart from the friend who is there calling herself a doula. She may not understand how best to work in the medical situation. But having a support system is imperative.

How a woman feels about her birth is something that will be with her forever. Being listened to and respected is paramount and doulas do make an impact with helping her feel this way.

Brenda at South GA Birth Services has a blog and offers podcasts of different birth related subjects. She recently interviewed me and has the podcast up for you to listen to if you are so inclined. It is about being a doula- becoming a doula and what a doula does. http://bellycaster.blogspot.com/

Hope you enjoy it!

Brenda has since moved to the Atlanta Metro area as a home birth midwife. You can find her at https://www.facebook.com/metromidwife

How Do I Know What I Know?
by Teresa Howard

Experience is something that comes from many sources. I feel that I learn something from each birth I attend. I have personally given birth three times unmedicated. I think my experiences were good ones and I want that for others. I have breastfed all three of my children and was a La Leche League leader for many years. That too is an experience that I cherish and love helping new moms make this a good experience for them as well. Experience comes in many ways- personally having done something, training by other in techniques and being involved with someone else while they are doing it.

I began as a doula in May of 1992 when a friend asked me to come and be with her as a companion to her and her husband. I did this again for a friend in February of 1996. Later that year, in July, I was asked by a friend to be there for her at her fifth birth, my third as a companion. In 1997 I again offered to come and offer guidance to two friends in April and again in November. Then a special invitation to accompany a mom who was my second birth came in January of 1998. I offered my help to a teen friend in March of 1998 and soon after took my doula training as I was hooked at being at births!

My first professional doula birth was in May of 1998. By year end I had attended my 27th birth. The year 2000 allowed me to attend my 100th birth on Christmas Day! In February my youngest daughter gave birth to a son- I attended as her mom and she had a doula- but I feel I used my doula skills at that one for sure! In May 2003 I had the privilege of doulaing my oldest daughter at her birth – that was my 200th birth! At the end of 2008 I had completed my 400th birth as a doula. I average three births per month now and stay really busy.

In the past I have enjoyed being the state representative for CAPPA as well as a labor and postpartum doula trainer and a lactation educator trainer with them. I now stay quite busy running a company of a dozen doulas who cover most of the metro area. I really get affirmation after each birth, after each childbirth class I teach, I know what I am doing now is definitely what i am supposed to be doing. I have found my calling! So many people don’t enjoy their work or don’t find it fulfilling. That is certainly not my situation!

As a company we have done close to 900 labor supports as a group!

TRAINING
• DONA Labor Doula Training, Anne Tumblin, RN
• When Survivors Give Birth, Penny Simkin, PT
• Precipitous Labor, Emergency Childbirth, Debbie Pulley, CPM
• Birthing From Within, Pam England, CNM
• Joy of Labor, Northside Hospital
• Prenatal Parenting, Frederick Wirth, MD
• Lactation FastTrack
• Midwifery Workshop, Ina May Gaskin, CPM
• Psychotropic Medicine during pregnancy and lactation, Z.Stowe, MD
• Infant and Child CPR
• Another Look, Breastfeeding and HIV, Miriam Thompson
• Physiologic Closure of the Cord, Anne Frye, CPM
• Spinning Babies, Gail Tully, CPM
• Advanced Doula Training- Massage and Reflexology, Donna Johnson, CMT
• Advanced Lamaze Training- Mission Impossible, Ann Tumblin, RN
• Supporting Women through Perinatal Death, Miriam Maslin
• Escorting Women on their Inner Journey, Miriam Maslin
•1st Advanced Skills for Birth and Postpartum Professionals with Leadership from CAPPA

Advanced Doula Training in Acupressure Techniques for Pregnancy, Labor and Postpartum 2014

 

• Dancing For Birth Trainer Certification Workshop with Stephanie Larson

  • BOLD Training for Childbirth Facilitator Training and Certification

CONFERENCES
• LLLI conference 1980
• DONA conferences 1998, 2000
• CAPPA conferences 2000, 2001, 2002* 2004*, 2007, 2008, 2014
• Georgia LLL Conference 2001
• Summit for Safe Motherhood 2001
• Gentle Birth World Congress 2007
• International Cesarean Awareness Network 2009

*also emceed

SPEAKING ENGAGEMENTS
• Georgia LLL Conference 2001
• Joy of Labor Training, Northside Hospital 2001
• Stillwater Yoga Prenatal Workshop 2002
• Prenatal Yoga in Athens, GA 2002-2007
• Natural Mama Expo 2002, 2003
• Interviewed and Appeared on REAL MOMS, REAL STORIES, REAL SAVVY Leading the Way in Women’s Health Programming on Public Television
• Panel for questions and answers Birth, the Play by Karen Brody
• International Cesarean Awareness Network:Concurrent Session 2009