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.

 

I had a mom call me the other day who was interested in hiring a doula. She was already in her last weeks of her pregnancy. She thought it was odd that someone would hire a doula ahead of time. This got me thinking about the value of a relationship with your doula before birth.

Sometimes folks hire a doula really early in their pregnancy. And then they hardly communicate with her. An occasional phone call or email is all that occurs prior to the 34 week prenatal visit that we try to schedule. This prenatal visit is a time to go over a birth questionnaire that we may have sent them. It enables us to figure out what an ideal birth would look like and how they see their future needs during their labor and birth. It also allows us to review options they may not have yet considered regarding their care and their baby’s needs.

Sometimes folks hire a doula really early in their pregnancy and then begin building a relationship with frequent contact. Lots of phone calls and emails. They apologize for the frequent contact- although most of us love it! They may even take our classes. This offers a great opportunity to really have insight into their birth dreams and ideals as we get to know them. It also helps us to figure out what this mom may really desire for her birth even prior to that prenatal meeting.

Sometimes folks hire a doula really late in their pregnancy. And then we struggle to get in a prenatal with enough time to really figure out how we will work together. But we work hard to make that happen.

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But are the birth outcomes really so different with these clients? I am not sure they are! Having been a doula for almost two decades, I feel I can step in fairly quickly and assess a mom’s needs with only a little conversation. But I may miss some of the details- like she really likes her shoulders massaged and hates her feet massaged- but overall I think I can go with her flow fairly well. And sometimes it is not necessary to have the time but for me personally, it is certainly the dessert that enhances the meal!

But different women have different needs. Some really feel very comfortable with little contact prior to the big day. And others really need that relationship. It is not about me and what I like, but again, this is her experience and I need to be able to let her direct her needs. I feel she needs to be able to direct her needs and not the other way around. (more…)

We hear it all the time… “Haven’t you had that baby yet?”  “When is that doctor gonna induce you? You look miserable!” “I am waiting for my grandbaby- when is he coming?”

Friends and family are excited and anxious and are only sharing this when they make these comments. But every time the phone rings it is a reminder that you are still pregnant! You are trying to not be anxious. You are trying to be patient and trust your body. These phone calls are not helping!

May I make a few suggestions? When you first get your estimated due date- don’t tell folks the exact date. Give them a due month. “I am due sometime in June.” That helps folks- and you not be so dedicated to the actual day. Only 4% of babies actually come on that estimated due date. There is an assumption that all women have 28 day cycles and ovulate on day 14… but guess what- many don’t! It is assumed you conceived on the day you had sex….but guess what- sperm can hang out- especially the girl ones- for days before you become pregnant. And some women are slow cookers and some are fast. Who knows what you are?

If you have already given folks that date, then my I suggest this? Put a recording on your phone message. “Hey this is Mindy, we have not had our baby girl yet. When we do, we will put the stats on this message! For now, we are resting and preparing for her arrival. If you really need to leave a message please do so after the tone. I may or may not return it depending on how urgent you need a reply. Thanks for understanding.” And then quit answering the phone from all the well wishers who don’t seem to understand they are adding to your stress!

Often times the partner in my childbirth classes feels coerced to attend the classes. They will remark at the first class that they came cause their partner made them come. Now I will say that that is usually not the feelings the dads have at the end of my series. In fact, I am usually met with strong hugs from the dads telling me how much they enjoyed the classes and how equipped they feel.

Recently we had a doula client who was super informed. She had decided on a one day, three hour class for the sake of time and her partners desire for it to be short and sweet. The idea of paying $225 for a six week, 18 hour class seemed over kill to him. (more…)

I attended a VBAC yesterday that would not have happened if she had stayed at her previous practice. This mom interviewed us late. She was already 32 weeks when she sat down with one of the Ladies of the Labyrinth and made the decision to hire us. Then we had her prenatal meeting at 35 weeks. She expressed the kind of birth experience she desired and I knew she would be hard pressed to do this at her current practice. We discussed how she would need to fight to get what she wanted. She was ready for the fight. But that night she tossed and turned thinking about the idea of having to fight during her labor- something no one should have to do. She called me the next morning to say she was ready to change practices and locations. (more…)

Often couples are confused by the roles the different players will have in their labors. I thought I would offer some descriptive words of who does what in the usual labor. Some roles may overlap and others will not. I am sure there are responsibilities I may miss. Some nurses and midwives, when able to, offer similar labor support as a doula. Some midwives are more like a doctor in the way they practice. Each provider of support offers their expertise and personality into your labor.One doctor may bring laughter and encouragement when another only arrives to catch the baby. Often times one nurse has two patients and may be watching another while a birth is occurring or a nurse is on break. Some midwives may be sleeping after being up all night or busy with several moms in labor. Feel free to add more in the comments section. What did your partner, nurse, doctor, midwife or doula do for you?

Partner:

  • 31671_448261040184_48618835184_6041736_2120044_nloves you
  • attends childbirth classes with you
  • practices pain coping skills learned in classes
  • is your companion
  • supports your choices
  • drives you to your birth location
  • gets your snacks, juice or ice
  • reminds you of the things you learned in class
  • massages
  • offers counter pressure
  • dances with you
  • walks with you
  • encourages you
  • helps set up your birth environment- music, etc,
  • offers kisses and hugs
  • 8522_174491805184_48618835184_4043917_4157419_ncries and laughs with you
  • sits by you and holds your hand
  • pours water on your belly
  • reminds you of your birth goals
  • holds you when need support
  • stays with you throughout labor
  • catches the baby
  • cuts the cord
  • holds the newborn
  • takes photos
  • reminds you of the things you learned about breastfeeding

Nurse:

  • 2347_84943840184_48618835184_2670186_287244_nmay support your choices but reminds you of hospital protocol
  • takes notes for medical records
  • brings you the forms you must sign prior to procedures
  • informs you of normal protocol for patients as they represent the hospital
  • brings you a hospital gown
  • places your IV if you desire
  • changes your linens and bed pads
  • monitors the baby via external or internal monitors
  • accesses your health- temperature, blood pressure, etc
  • does vaginal exams
  • places catheters and shaves you if needed for surgery
  • gets your  ice
  • calls for anesthesia
  • n48618835184_1659967_2531gets your medication if desired
  • encourages you
  • sets up the birth tub if desired and offered
  • offers suggestions that may help- sometimes things you did not want – like medication
  • instructs you on guided pushing
  • holds your leg during pushing
  • assist the doctor or midwife during birth
  • catches the baby if the doctor or midwife does not arrive in time
  • cleans up after the birth and gets your ice pack
  • massages your fundus after the birth
  • records the time of birth
  • weighs and measures the baby
  • washes the newborn
  • does newborn procedures- shots, ointment, etc
  • may help you with breastfeeding

Doctor:

  • n48618835184_1659963_4891determines your health and well being during your pregnancy
  • may determine if you need to come to the hospital
  • assesses the baby’s health in utero
  • writes orders for medical procedures
  • may do vaginal exams or may have nurse do most of them
  • is either patient or actively managing your labor
  • breaks your amniotic sac if desired
  • comes in for short visits when needed
  • determines if you need intervention
  • answers your medical questions
  • surgically delivers the baby if a cesarean is decided upon
  • arrives to catch when birth is imminent
  • does any repairs that are needed
  • cuts the cord if needed
  • delivers or catches the placenta

Midwife:

  • 8522_174491830184_48618835184_4043920_3788797_nworks with you prenatally to prepare for your birth
  • helps you uncover all of your options
  • supports your choices
  • determines your health and well being during your pregnancy
  • may determine if you need to come to the hospital
  • assesses the baby’s health in utero
  • writes orders for medical procedures
  • is either patient or actively managing your labor
  • breaks your amniotic sac if desired
  • comes in for short visits when needed but may stay longer than a doctor if not busy
  • determines if you need intervention
  • may do vaginal exams or may have nurse do most of them
  • massages if not busy with other patients
  • answers your non medical and medical questions
  • offers ideas you may not have considered
  • n48618835184_1659957_8627guides you and your partner when you need it
  • reminds you of your birth goals
  • holds you when need support
  • encourages you
  • offers hugs
  • assists the doctor in surgery of the baby if a cesarean is decided upon
  • arrives to catch when birth is imminent but often will be more present in the last leg of the labor
  • does any repairs that are needed
  • cuts the cord if needed
  • delivers or catches the placenta
  • helps you with breastfeeding

Doula:

  • 8522_174491890184_48618835184_4043931_378758_nworks with you prenatally to prepare for your birth
  • helps you uncover all of your options
  • cares about you personally
  • is your companion
  • supports your choices
  • rides with you to your birth location
  • gets your snacks, juice or ice
  • reminds you of the things you learned in class
  • massages
  • answers your non medical questions
  • helps you get answers to medical questions
  • offers counter pressure
  • 29421_387236166617_508296617_4397358_8096667_ndances with you
  • offers ideas you may not have considered
  • guides you or your partne when you need it
  • walks with you
  • encourages you
  • helps set up your birth environment- music, etc,
  • offers hugs
  • cries and laughs with you
  • sits by you and holds your hand
  • pours water on your belly
  • reminds you of your birth goals
  • holds you when need support
  • supports your partner
  • becomes your primary support if your partner needs a nap or meal
  • stays with you throughout labor
  • takes photos
  • helps you with breastfeeding

DONA has created a new video regarding doulas. If you are curious about the role of a doula and a bit about her scope of practice if she is DONA certified, this video will help to enlighten you! Enjoy!

Today I was adding the numbers of births each labor doula in our group has done over the years. These were births where they offered labor support. And within our group I was totally amazed to figure out that we have more than 1000 births of experience. Experience is not the only reason to hire a doula. There are a lot of factors to consider: how you feel when you are around her, how vulnerable you feel you can be with her,  how your partner feels about her, and many more factors that are as individual as you are. But with our group you hire a doula or a team of doulas (Ladies of the Labyrinth), but you get the whole gamete of experience. Because when a doula is at a birth, she knows she can call any of the more experienced doulas in our group for insight and guidance in a situation with which she may not be familiar. I can guarantee you that there is no more experienced doula group in Atlanta than our group. I hope you will consider us when you are selecting someone to be guiding and supporting you in your labor!

“I am interested in hiring a labor doula. What do you need to know and what do I need to do next?”

* First, you have made a great decision regarding including a labor doula at your birth. The studies show :

¨ tends to result in shorter labors with fewer complications
¨ reduces negative feelings about one’s childbirth experience
¨ reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
¨ reduces the mother’s request for pain medication and/or epidurals
¨ Feel more secure and cared for
¨ Are more successful in adapting to new family dynamics
¨ Have greater success with breastfeeding
¨ Have greater self-confidence (more…)